APPLICATION FOR REGISTRATION OF LIMITED COOPERATIVE ASSOCIATION NAMEFOREIGN LIMITED COOPERATIVE ASSOCIATIONS ONLY Submit in Duplicate Secretary of State P.O. Box 94608 Lincoln, NE 68509 www.sos.ne. Attach a certificate of existence or authorization from the state or country of organization executed by the official having custody of such records. Name of Limited Cooperative Association Organized under the laws of Date of Organization Nature of affairs in which association is engaged Registration is good for 120 days. DATED Signature of Officer or Authorized Representative Printed Name and Title FILING FEE: For Profit $35.00 plus $5.00 per page for any additional pages Not for Profit $35.00 plus $5.00 per page for any additional pages Neb. Rev. Stat. 21-2908 American LegalNet, Inc. www.FormsWorkFlow.com