APPLICATION FOR CERTIFICATE OF AUTHORITY Secretary of State Office 500 E Capitol Ave Pierre, SD 57501 (605)773-4845 FOREIGN COOPERATIVE Please Type or Print Clearly in Ink Please submit one Original and one Photocopy FILING FEE: $550 payable to SECRETARY OF STATE Telephone # ____________________ FAX # _______________________ Application must be accompanied by a one page original certificate of existence issued by the Secretary of State or other official having custody of the corporate records in the state or country under whose law it is incorporated. 1. The name of the cooperative is _____________________________________________________________________ ______________________________________________________________________________________________ Note: This must be the exact cooperative name. 2. State where incorporated __________________________________ 3. Date of its incorporation is __________________________________ 4. The period of its duration ___________________________________ 5. The address of its principal office in the state where incorporated ______________________________________________________________________________________________ Street Address City State ZIP+4 ______________________________________________________________________________________________ Mailing Address (Optional) City State ZIP+4 6. The South Dakota Registered Agent name ____________________________________________________________ ______________________________________________________________________________________________ Street Address (Required to be a South Dakota Address) City State ZIP+4 ______________________________________________________________________________________________ Mailing Address (Optional – Required to be a South Dakota Address) City When listing a Commercial Registered Agent, please state their CRA #. This number can be obtained from the Commercial Registered Agent. State ZIP+4 _______________________________ American LegalNet, Inc. www.FormsWorkflow.com 7. The purposes which it proposes to pursue in the State of South Dakota 8. The names and usual business addresses of its current directors and officers. Please place a check mark next to the name if the principal officer serves as a director. _____________________________________________________________________________________________ President Street Address City State ZIP+4 _____________________________________________________________________________________________ Vice President Street Address City State ZIP+4 _____________________________________________________________________________________________ Secretary Street Address City State ZIP+4 _____________________________________________________________________________________________ Treasurer Street Address City State ZIP+4 _____________________________________________________________________________________________ Director Street Address City State ZIP+4 _____________________________________________________________________________________________ Director Street Address City State ZIP+4 _____________________________________________________________________________________________ Director Street Address City State ZIP+4 9. The aggregate number of members and class of those members, if any: Number of Members Class _______________________ ________________________________ _______________________ ________________________________ _______________________ ________________________________ 10. The aggregate number of shares which it has authority to issue, itemized by classes, par value of shares, shares without par value, and series, if any, within a class. Number of Shares Class Series Par value per share or statement that shares are without par value _____________ ____________ _________________ _________________________________________ _____________ ____________ _________________ _________________________________________ _____________ ____________ _________________ _________________________________________ American LegalNet, Inc. www.FormsWorkflow.com 11. The aggregate number of issued shares which it has authority to issue, itemized by classes, par value of shares, shares without par value, and series, if any, within a class is: Number of Shares Class Series Par value per share or statement that shares are without par value _____________ ____________ _________________ _________________________________________ _____________ ____________ _________________ _________________________________________ _____________ ____________ _________________ _________________________________________ The application must be signed by an authorized officer of the cooperative in front of a notary public. Dated ____________________________ ______________________________________________ (Signature of an authorized officer) ______________________________________________ (Printed Name) ______________________________________________ (Title) STATE OF _____________________________ COUNTY OF ___________________________ On this the ___________ day of _________________________, 20 ____ before me personally appeared ____________________________________________________________ known to me or satisfactorily proven to be the person who is described in, and who executed the within instrument and acknowledged to me that she/he/they executed the same. __________________________________ My Commission Expires ______________________________________________ Notary Public Notarial Seal Foreigncoopcertificateof authority July 2008 American LegalNet, Inc. www.FormsWorkflow.com