APPLICATION FOR CERTIFICATE OF AUTHORITY LIMITED COOPERATIVE ASSOCIATION (FOREIGN) Submit in Duplicate , Secretary of State P.O. Box 94608 Lincoln, NE 68509 (402)471-4079www.sos.ne.An original certificate of good standing or existence from the state or country of organization executed by the official having custody of such records must be filed with this application. NOTE: A certified copy of the company's articles of organization may not be filed in lieu of a certificate of good standing or existence. Name of Limited Cooperative Association Alternative Name (only used when the associations name does not comply with Neb. Rev. Stat. 21-2908) Organized under the laws of the State/Jurisdiction of Address of Designated office in this state: NE Street and Mailing Address City State Zip Address of Designated office in state of organization IF such address is required by state of organization: Street and Mailing Address City State Zip Name and address of registered agent in Nebraska: Registered Agent Name: Address: NE Street and Mailing Address CityZip Signature of Officer or Authorized RepresentativePrinted name of Officer or Authorized Representative FILING FEE: For Profit $145.00 plus $5.00 per page for any additional pages Not for Profit $25.00 plus $5.00 per page for any additional pages Neb. Rev. Stat.21-29, American LegalNet, Inc. www.FormsWorkFlow.com OFFICERS: DIRECTORS: Name/Title Name Street and Mailing Address Street and Mailing Address Name/Title Name Street and Mailing Address Street and Mailing Address Name/Title Name Street and Mailing Address Street and Mailing Address Name/Title Name Street and Mailing Address Street and Mailing Address Name/Title Name Street and Mailing Address Street and Mailing Address Name/Title Name Street and Mailing Address Street and Mailing Address Name/Title Name Street and Mailing Address Street and Mailing Address Name/Title Name Street and Mailing Address Street and Mailing Address Name/Title Name Street and Mailing Address Street and Mailing Address Please Copy this page and submit additional pages if needed. American LegalNet, Inc. www.FormsWorkFlow.com