FILE ONE ORIGINAL (Two if you want a filedstamped copy returned to you)FEE: $15.00 Control #**** The undersigned adopt the following Statement of Agent of Process for Unincorporated **** Non-Profit Association according to West Virginia Code 1.The name of the Unincorporated Non-ProfitAssociation shall be: 2.The principal office address of theStreet: association will be:City/State/Zip:located in the County of:County:The mailing address of the association, Street/Box:if different, will be: City/State/Zip:3.The name and address of the agent (person orcompany) to whom notice of service ofprocess may be sent in West Virginia is:agent (person orName:in West Virginia is: Street: City/State/Zip:4.Contact name and number of person to reach in case of problem with filing: (Optional, however, listing one mayhelp to avoid a return or rejection of filing if there appears to be a problem with the document.)Name: Phone: Business e-mail address, if any: 5.Acknowledgement and Signatures* (This statement must be signed and acknowledged by a person authorized to managethe affairs of an unincorporated non-profit association. The statement must also be signed by the person appointed as agent in item#3 above, who thereby accepts the appointment.):Signature of Applicant(authorized to act on behalf of the association): Signature of Appointed Agent: *Important Legal Notice Regarding Signature : Per West Virginia Code24731D-1-129 . Penalty for signing false document.Any person who signs a document he or she knows is false in any material respect and knows that the document is to be delivered to the Secretary of State for filing is guilty of a misdemeanor and, upon conviction thereof, shall be fined not more than one thousand dollars or confined in the county or regional jail not more than one year, or both.CHARITABLE REGISTRATION: If your company receives contributions, donations or grants, registration as a charitable organization may be required. Contact our office for more information or visit our website at w ww.wvsos.gov . Important Note : This form is a public document. Please do NOT provide any personal identifiable information on this form such as social security number, bank account numbers, credit card numbers, tax identification or driver222s license numbers. 24736-11 .Form UNA-1 Rev. 11/2017STATEMENT OF AGENT OF PROCESS FOR UNINCORPORATED NON-PROFIT ASSOCIATIONWest Virginia Secretary of State Business & Licensing Division Tel: (304)558-8000 Fax: (304)558-8381 Website: www.wvsos.gov CHOOSE ONE OF THE FOLLOWING PROCESSING SERVICES: 1 EXPEDITED SERVICE (24-hour, 2-hour and 1-hour; *Requires standard filing fee plus additional expedite fee, see below) West Virginia Secretary of State Business & Licensing Division Tel: (304) 558-8000 Fax: (304) 558-8381 Website: www.wvsos.gov Filing Submission Instructions - Business Division SUBMIT THE COMPLETED APPLICATION WITH THE CUSTOMER ORDER REQUEST FORM TO ONE OF THE OFFICES BELOW. CHOOSE EXPEDITED OR STANDARD PROCESSING SERVICE. IF NOT USING THE CUSTOMER ORDER REQUEST FORM AND YOU ARE REQUESTING EXPEDITED SERVICE, YOU MUST INCLUDE THE WORD "EXPEDITE" AND THE LEVEL OF EXPEDITED SERVICE BEING REQUESTED (24-HOUR, 2-HOUR OR 1-HOUR) IN YOUR CORRESPONDENCE. BE SURE TO INCLUDE THE CORRECT ADDITIONAL EXPEDITED FEE. THIS FEE IS IN ADDITION TO THE REGULAR FILING FEE (SEE FEES BELOW).BUSINESS SERVICE CENTERS Standard and Expedited Filings Charleston Office One-Stop Business Center 1615 Washington Street East Charleston, WV 25311 Phone: (304) 558-8000 Fax: (304) 558-8381 Hours: Mon. - Fri. 8:30a - 5:00p EST Clarksburg Office North Central WV Business Center 200 West Main Street Clarksburg, WV 26301 Phone: (304) 367-2775 Fax: (304) 627-2243 Hours: Mon. -Fri. 9:00a - 5:00p EST Martinsburg Office Eastern Panhandle Business Center 229 E. Martin Street Martinsburg, WV 25401 Phone: TBA Fax: TBA Hours: Mon. - Fri. 9:00a - 5:00p ESTIMPORTANT: READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING FORMS. Please follow the instructions included with the application. Failure to include any of the required information on the form may cause the filing to be rejected.All forms may be downloaded from our web site www.wvsos.gov . Rev. 8/2018 *Fee$ 25.00 $250.00 $500.00 Expedite Service 24-Hour 2-Hour 1-HourEXPEDITED SERVICE requests may be submitted by: - E-mail to efilings@wvsos.gov - Fax - Walk in delivery 2 STANDARD PROCESSING (5-10 business days) SUBMIT COMPLETED FILING TO ONE OF THE BUSINESS CENTERS BELOW: INCLUDE PAYMENT: Be sure to enclose the correct filing fee with your filing. Your filing will be rejected if the correct payment amount is not included. Credit Card Payments - If paying by credit card, you must include a valid telephone number where you can be reached by one of our administrative filing specialists in order to provide credit card payment information. Your filing will be rejected if a valid phone number is not included, and/or if we are unable to obtain valid credit card payment information. Standard filing fees apply.STANDARD PROCESSING requests may be submitted by: - E-mail to CorpFilings@wvsos.gov - Fax - Walk in delivery (drop off service only filed within 5-10 business days) Please provide a phone number below where you may be reached to provide credit card information. Credit Card READ CAREFULLY BEFORE SUBMITTING - Expedite service is NOT AVAILABLE for the following filings: West Virginia Secretary of State Business & Licensing Division Tel: (304)558-8000 Fax: (304)558-8381 Website: www.wvsos.gov Customer Order RequestSUBMIT THIS COMPLETED FORM WITH YOUR FILING. Order Processing Requested*: * * * Expedite Processing Requires Additional Fees * * * Standard Processing** 24-HOUR Expedite*** 2-HOUR Expedite 1-HOUR Expedite Name of Entity: Return filing to: (Return Address) Contact Name: Phone: Return Delivery Options: Email or Fax options do not receive a copy via mail; must be ordered separately. Email to: Fax to: Hold for Pick Up UPS: Acct # Other (explain below): (additional $500.00 fee included)(additional $25.00 fee included)(additional $250.00 fee included) FedEx: Acct # Mail to Return Address above Order Description (include items being ordered and fee breakdown): *PLEASE NOTE: Original paperwork is kept by this office. Include a copy of the original filing ifyou want a file stamped copy returned to you at no extra charge. Certified copy requests are an additional $15 per certified copy being requested. Total Amount: Payment Method: Cash (Do Not mail cash) Pre-paid Acct #: Check/Money Order *"Processing" indicates the filing will be completed and registered in the Secretary of State registration database. **Standard Processing applications received by E-MAIL or FAX require credit card payment. Contact Office Cashier at (304) 558-8000. ***NOTE: Orders filed in person through any Secretary of State office location requesting the filing be processed will be assessed a 24-HOUR Expedite fee of $25.00 per order.(Avg. processing turnaround 5-10 business days)Rev. 8/2018Attach signed pre-paid slip. >> Tax Department filings including Sole Proprietorships, General Partnerships, and Associations >> Dissolution or Withdrawal of Corporation, Voluntary Association or Business Trust Email to: CorpFilings@wvsos.govEmail to: eFilings@wvsos.gov Phone (if different from above): 24-hour, 2-hour and 1-hour Expedite Service GuidelinesMAC WARNER Secretary of State State Capitol Building Charleston, WV 25305 Phone: (304) 558-6000 Website: www.sos.wv.gov IMPORTANT: To ensure expedited service, please mark 223EXPEDITE224 in a conspicuous place at the top of the service request. Please indicate method of delivery. 24-HOUR EXPEDITE SERVICE The Secretary of State offers a 24-hour expedite service on most business organization filings processed by this office. If you choose to utilize this service, please enclose with your filing the additional expedite fee. Please note that this expedite fee is in addition to the standard fee charged on each filing and/or order. You must mark the document with your 22324-HOUR EXPEDITE224 request. If using a cover letter, note that you are requesting 24-hour expedited service, and include your telephone numbe