Secretary of State Office 500 E Capitol Ave Pierre, SD 57501 (605)773-4845 corpinfo@state.sd.us QUALIFICATION FOR FARMING DOMESTIC BUSINESS CORPORATION SDCL 47-9A Please Type or Print Clearly in Ink NO FILING FEE Telephone # ________________ 1. The Name and Business ID of the corporation is: Name (Note: This must be the exact corporate name as registered.) Business ID 2. The state of incorporation: South Dakota 3. The South Dakota Registered Agent's name South Dakota law permits the registered agent to be either: A) noncommercial registered agent (this may be an individual), B) a commercial registered agent, or C) an office holder. Complete only one below, either (a) or (b) or (c). (a) The South Dakota Noncommercial Registered Agent's name Actual Street Address in this State City State ZIP+4 Mailing Address in this State, if Different from Street Address City State ZIP+4 _____________________________________________________________________________________________________________________ Email Address (Optional) (b) When listing a Commercial Registered Agent, please state their CRA#. This number can be obtained from the Commercial Registered Agent. Commercial Registered Agent Name CRA# (c) Title of the office or other position with the corporation Business Office's Actual Street Address in this State City State ZIP+4 Mailing Address in this State, if Different from Street Address City State ZIP+4 _____________________________________________________________________________________________________________________ Email Address (Optional) 4. List the acreage and location by section, township and county of each lot or parcel of land in this state owned or leased by the corporation and used for the growing of crops or the keeping or feeding of poultry or livestock (You may attach additional pages if necessary). Acres Section Township County Acres Section Township County Acres Section Township County Acres Section Page 1 of 2 Township County American LegalNet, Inc. www.FormsWorkFlow.com 5. Is the majority of the voting stock held by members of a family, an estate of a family member, or a trust that benefits members of the family? Yes No 6. Is at least one of the stockholders: (a) a person residing on the farm? (b) a person actively operating the farm? (c) a person who has resided on the farm? (d) a person who has actively operated the farm? Yes Yes Yes Yes No No No No 7. State the number of shares owned by persons residing on the farm or actively engaged in farming or their relatives within the third degree of kindred (You may attach additional pages if necessary). Name Name Name Name Name Address Address Address Address Address City City City City City State State State State State Zip Zip Zip Zip Zip Shares Shares Shares Shares Shares DOK DOK DOK DOK DOK 8. Are all the shareholders either natural persons, estates of a family member, or a trust that benefits members of the family? Yes No 9. The percentage of gross receipts of the corporation derived from rent, royalties, dividends, interest, and annuities: _____% 10. State the number of shareholders. _____ 11. Is there more than one class of stock? Yes No 12. As to each shareholder state the name, address, number of shares owned, and degree of kindred (DOK). Name Name Name Address Address Address City City City State State State Zip Zip Zip Shares Shares Shares DOK DOK DOK No person may execute this report knowing it is false in any material respect. Any violation may be subject to a civil and/or criminal penalty (SDCL 47-1A-129; 22-39-36). Dated Signature of an authorized person Email (Optional) Printed Name Page 2 of 2 corporationfarmqualification Sept 2016 American LegalNet, Inc. www.FormsWorkFlow.com