PAUL D. PATE Secretary of State State of Iowa Application for Reinstatement of a COOPERATIVE ASSOCIATION [Chapter 499] TO THE SECRETARY OF STATE OF THE STATE OF IOWA: Pursuant to section 499.78 of the Code of Iowa, the undersigned Cooperative Association applies for reinstatement and states: 1. The name of the Cooperative Association on the date of administrative dissolution was: ________________________________________________________________________ 2. 3. The date of the administrative dissolution was: ____________________________________ The ground or grounds for dissolution (check one): did not exist (explain why here) has been eliminated (explain how here) 4. The Cooperative Association applies for reinstatement under the name: ________________________________________________________________________ (Complete only if the name of the Cooperative Association at the time of the administrative dissolution is no longer available on the records in this office.) Signature ________________________________________________________________ Title _______________________________________________ Date ________________ The filing fee is $5.00. Make checks payable to SECRETARY OF STATE. 635_0130 rev. 1/15 American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS NOTES: 1. 2. The filing fee is $5.00. Make checks payable to SECRETARY OF STATE. The document is to be signed by the chairperson of the board of directors, the president, or other officer of the cooperative association. If directors have not been selected, the document is to be signed by an incorporator. If the cooperative association is in the hands of a court-appointed fiduciary, the document is to be signed by the fiduciary. A copy of a signature is acceptable for filing. Verification is not required. One copy of the document is to be delivered to the Secretary of State for filing. If the cooperative association was administratively dissolved due to failure to comply with annual reporting requirements, the cooperative association must file all delinquent annual reports and pay delinquent fees. The annual reports and fees should accompany the application. If the cooperative association was administratively dissolved due to failure to maintain a registered agent or registered office, the cooperative association must name a registered agent and office at the time of filing this application. The reinstatement relates back to the effective date of the administrative dissolution. The information you provide will be open to public inspection under Iowa Code chapter 22.11. 3. 4. 5. 6. 7. SECRETARY OF STATE Business Services Division Lucas Building, 1st Floor Des Moines, IA 50319 Phone: (515) 281-5204 FAX: (515) 242-5953 Website: sos.iowa.gov American LegalNet, Inc. www.FormsWorkFlow.com