State of Missouri Corporations Division PO Box 778 / 600 W. Main St., Rm. 322 Jefferson City, MO 65102 John R. Ashcroft, Secretary of State 1. The Corporation's name is Application for Certificate of Authority of a Foreign Nonprofit Corporation (Submit with filing fee of $25.00) 2. If the corporation's name is unavailable, the name it will use in Missouri is 3. The date of its incorporation was 4. The address of its principal place of business is month/day/year Address and it is organized and existing under the laws of , and the period of its duration is City/State/Zip 5. The name and physical address of its registered agent and office in the State of Missouri is Name Address 6. The names of its officers and directors and their business or home addresses are as follows (attach additional sheets as necessary): President Name Address City/State/Zip City/State/Zip Vice President Secretary Director Director Treasurer 7. The specific purpose(s) of its business in Missouri: (Please see next page) Name and address to return filed document: Name: Address: City, State, and Zip Code: Corp. 55A (01/2017) American LegalNet, Inc. www.FormsWorkFlow.com 8. Does the corporation have members? Yes 10. 9. If incorporated in Missouri would the corporation be a public benefit No 11. The effective date of this document is the date it is filed by the Secretary of State of Missouri unless a future date is otherwise indicated: In Affirmation thereof, the facts stated above are true and correct: (The undersigned understands that false statements made in this filing are subject to the penalties provided under Section 575.040, RSMo) Authorized signature of officer or chairman of the board Date may not be more than 90 days after the filing date in this Office Check box if you will be registered with the Department of Agriculture as a Family Farm or Authorized Farm Corporation as defined by section 350.010 RSMo. or mutual benefit Corporation? Note: You must submit a current (not more than 60 days old) certificate of good standing or certificate of existence with this application. This may be obtained from the Secretary of State or other authority that issues corporate charters in your state of domicile. Printed Name Title Date Corp. 55A (01/2017) American LegalNet, Inc. www.FormsWorkFlow.com