REINSTATEMENT/REINCORPORATION 
                                                  
Reinstatement and Reincorporation Requirements: 
                                                  
a.  Copy of Articles and all amendments certified by the clerk of the circuit court. 
 
b.  Application for Reinstatement and Reincorporation (completed). 
 
c.  Certificate of Reincorporation and registered agent designation & acceptance (completed). 
 
d.  Fees (as shown below). 
 
NOTE: 
 
“Reinstatement/Reincorporation” is for not for profit corporations that were legislatively or judicially 
created prior to September 1, 1959, and have never been reflected on the records of the Division of 
Corporations.  These corporations were dissolved by operation of law (s.617.1623(1), F.S.) on July 2, 1992. 
 Reincorporation allows for the future filing of annual reports, amendments, and any other corporate 
documents.  The corporation, once reinstated, shall then be entitled to all privileges and powers as if 
originally incorporated under Chapter 617, F.S.  
 
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FEES: 
                                                  
Filing Fee                                         $35.00 
Registered Agent                                   $35.00 
Annual Reports                                     $61.25 per year from 1993 to present. 
 
OPTIONAL: 
Certified Copy $8.75 (plus $1 per page for each page over 8, not to exceed a maximum of  $52.50). 
Certificate of Status  $8.75 
                                                  
                 Make checks payable to Florida Department of State and mail to: 
                              Division of Corporations 
                              P.O. Box 6327 
                              Tallahassee, FL  32314 
                                                  
CR2E035 (3/00) 

   APPLICATION FOR REINSTATEMENT AND REINCORPORATION OF 
       LEGISLATIVELY OR JUDICIALLY CHARTERED NOT FOR PROFIT 
                                         CORPORATION 
 
IN COMPLIANCE WITH  s. 617.1623(1)(d), FLORIDA STATUTES, THE FOLLOWING IS SUBMITTED 
TO REINSTATE AND REINCORPORATE  A NOT FOR PROFIT LEGISLATIVELY OR JUDICIALLY 
CHARTERED CORPORATION WHICH WAS DISSOLVED ON JULY 2, 1992, PURSUANT TO s. 
617.1623(1)(c): 
 
1.                  
                      Name of corporation exactly as it appears in legislative or judicial charter. 
 
2.                                                                                                                                                               
                                        Street address of the principal office of the corporation.  
                      (This address will be used for the mailing of corporation annual reports) 
 
3.                  
                                      Date of legislative or judicial incorporation 
        
           ‰    FEI Number applied for 
4. FEI Number  __  __ - __ __ __ __ __ __ __           ‰    FEI Number not required 
        
5.  Name, address and title of current officers and/or directors: 
     (use additional page if necessary) 
  
  Title                         Name                               Street Address                                    City/State/Zip 

6.  Attached is a copy of the judicial charter and all amendments thereto certified by the Circuit Court of the 
county wherein recorded  ora copy of the chartering law certified by the Department of State, Division of 
Elections as to legislative charters and completed Certificate of Reincorporation.  
 
Authorized Signature 
 
Name and capacity of person signing application  
(see S. 617.10201(6)) 
                                                        

                              COVER LETTER 
  
 Department of State 
 Division of Corporations 
 P. O. Box 6327 
 Tallahassee, FL  32314 
  
 SUBJECT:                        
                              PROPOSED CORPORATE NAME – MUST INCLUDE SUFFIX 
  
 Enclosed is an original and one (1) copy of Reinstatement/Reincorporation and a check for: 
  
FEES: 
                                                
Filing Fee                                       $35.00 
Registered Agent                                 $35.00 
Annual Reports for 1993 through present year     $61.25 per calendar year 
 
OPTIONAL: 
 
 Certified Copy $8.75 (plus $1 per page over 8, not to exceed a maximum of $52.50) 
 Certificate of Status $8.75 
    
                              Name (Printed or typed) 
                                                 
                              Address 
                                                 
                              City, State & Zip 
                                                 
                              Daytime Telephone number 
 
                                  E-mail address: (to be used for future annual report notification) 
 

CERTIFICATE OF REINCORPORATION 
 
Pursuant to s. 617.0901, Florida Statutes, this certificate of reincorporation was duly authorized by a meeting of its 
members regularly called or by a meeting of its board of directors if there were no members entitled to vote on the 
reincorporation: 
 
ARTICLE I   NAME 
The name of the corporation shall be: 
 
ARTICLE II  PRINCIPAL OFFICE 
The principal place of business and the mailing address of this corporation shall be: 
 
ARTICLE III  PURPOSE 
The specific purpose for which the corporation is organized: 
 
ARTICLE IV   MANNER OF ELECTION 
The manner in which the directors are elected or appointed: 
 
ARTICLE V  INITIAL REGISTERED AGENT AND STREET ADDRESS 
The name and Florida street address of the registered agent is: 
 
ARTICLE VI  INCORPORATOR 
The name and address of the Incorporator is: 
 
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Having been named as registered agent to accept service of process for the above stated corporation at the place  
designated in this certificate, I am familiar with and accept the appointment as registered agent and agree to act in this 
capacity. 
  
 Signature/Registered Agent                                                               Date 
  
 Signature/Incorporator                                                                   Date