Farm/Ranch/Home Registration Apr2018 Secretary of State Office 500 E Capitol Ave Pierre, SD 57501 (605)773-3537 trademark@state.sd.us 1. Applicant: Address: City: State: Zip: 2. Name of Farm, Ranch, or Home: 3. Location of (Directions to) Farm, Ranch, or Home Headquarters: 4. List each County where the Farm, Ranch or Home owns property: 5. List the legal description in Each County where the Farm, Ranch or Home owns property (You may attach additional pages if necessary): *** This section is to be completed in the presence of a Notary Public *** State of ) )247247 County of ) I, , Printed Name of Authorized Person Title of Name of Business as Applicant do solemnly swear that the above-named applicant is the owner/representative of the above-named entity and that no other person has the right to use such name in the indicated county in the State of South Dakota either in the identical form thereof or in such near resemblance thereto as might be calculated to deceive or to be mistaken therefor. Dated Signature of authorized person Subscribed and sworn to before me this day of, 20 . Notary Public Signature (Notarial Seal) My Commission Expires Name of Farm, Ranch, and Home Registration Application SDCL 43-27-1 FILING FEE: $15 Make Check payable to SECRETARY OF STATE American LegalNet, Inc. www.FormsWorkFlow.com