Secretary of State Office 500 E Capitol Ave Pierre, SD 57501 (605)773-4845 APPLICATION FOR CERTIFICATE OF TRUST DOMESTIC BUSINESS TRUST Please Type or Print Clearly in Ink Please submit one Original and one Photocopy FILING FEE: $100 payable to SECRETARY OF STATE Telephone # ____________________ FAX # _______________________ Pursuant to the provisions of SDCL 47-14A, the undersigned business trust hereby submits a certificate of trust: 1. The name of the Business Trust is __________________________________________________________________ ______________________________________________________________________________________________ 2. The name and the business address of at least one of the trustees meeting the requirements set forth in SDCL 47-14A _______________________________________________________________________________________________ Trustee Business Address City State ZIP+4 3. The future effective date or time of effectiveness of the certificate if it is not to be effective upon the filing of the certificate is __________________________, 20 _________. 4. Any other information the trustees determine to set forth: A Certificate of Trust must be signed by all of the trustees. The execution of a certificate constitutes an oath or affirmation, under the penalties of perjury, that, to the best of the trustee’s knowledge and belief, the facts stated therein are true (SDCL 47-14A-51). Dated ____________________________ ______________________________________________ (Signature of a trustee) ______________________________________________ (Printed Name) ______________________________________________ (Title) Dated ____________________________ ______________________________________________ (Signature of a trustee) ______________________________________________ (Printed Name) ______________________________________________ (Title) domestictrust July 2008 American LegalNet, Inc. www.FormsWorkflow.com