DEPARTMENT OF CONSUMER AND REGULATORY AFFAIRS BUSINESS AND PROFESSIONAL LICENSING ADMINISTRATION CORPORATIONS DIVISION Government Of the District of Columbia DCRA Corporations Division P.O. Box 92300 WASHINGTON, D.C. 20090 STATEMENT OF ELECTION TO ACCEPT OF ________________________________________________________________ To: The Department of Consumer and Regulatory Affairs, Washington. D.C. Pursuant to the provisions of the District of Columbia Non-profit Corporation Act, the undersigned corporation elects to avail itself thereto. FIRST: The name of the corporation is __________________________. SECOND: A resolution recommending that the corporation accept the District of Columbia Non-profit Corporation Act was adopted in the following manner: (Note 1) THIRD: The purpose or purposes which it will hereafter pursue are _____________________________________________________________ _____________________________________________________________. (Note 2) FOURTH: A statement as whether or not the corporation is to have members ______________________________________________________________. FIFTH: The Corporation is to be divided into _____classes of members. The description of each class of members, the qualifications, rights and limitations of the members of each class and conferring, limiting, or denying the right to vote are as follows: SIXTH: A statement as to the manner in which directors shall be elected or appointed, if the directors or any of them are not t be elected or appointed by one or more classes of members, or that the manner of such election or appointment of such directors shall be provided in the bylaws__________________________________________ ____________________________________________________ American LegalNet, Inc. www.USCourtForms.com SEVENTH: Provisions for the regulation of the internal affairs of the cooperation, including provisions for distribution of the assets on dissolution or final liquidation. ___________________________ ___________________________________________________ EIGHTH: The address, including street and number, of its registered office in the District of Columbia is ________________________________ _____________________________________________________ and the name of its registered agent at such address is ____________________________________________________________ ____________________. NINTH: The names and respective addresses, including street and number of its officers and directors are: NAME _______________________ _______________________ _______________________ _______________________ _______________________ _______________________ _______________________ OFFICE Director Director Director President Vice Pres. Secretary Treasurer ADDRESS ________________ ________________ ________________ ________________ ________________ ________________ ________________ Date___________________ (CORPORATE SEAL) _____________________ Corporate Name By___________________ Its President or VP Attest: ____________________________ Its Secretary or Assistant Secretary American LegalNet, Inc. www.USCourtForms.com Notes: 1. 2. Insert whichever of the following statements is applicable: (a) “The resolution was adopted at a meeting of members held on _______________, at which a quorum was present, and the resolution received at least two-thirds of the votes which members present or represented by proxy at such meetings were entitled to cast”. (b) “The resolution was adopted by a consent in writing signed by all members entitled to vote with respect thereto.” (c) “The resolution was adopted at a meeting of the Board of Directors held on ________________, and received the vote of a majority of the Directors in office, there being no members having voting rights in respect thereof.” The purpose may be different from its existing purposes. For General Information Call: The Corporations Division - (202) 442-4432 Please check our corporate website to view organizations required to register, to search business names, to obtain step-by-step guidelines to register an organization, to search registered organizations, and to download forms and documents. Simply log onto our website at www.dcra.dc.gov, click on “Corporate Registrations” and procedure as prompted. To ensure timely and accurate processing of this document, mail all required forms and payment to: Department of Consumer and Regulatory Affairs Corporations Division P.O. Box 92300 Washington, D.C. 20090 For Overnight Delivery send to: Corporate Bank of America Attention: D.C. Government Wholesale Lockbox # 92300 Mail code MD4-301-18-04 18th floor 225 North Calvert Street Baltimore, Maryland 21202 American LegalNet, Inc. www.USCourtForms.com