APPLICATION FOR 
                                            PAUL D. PATE 
                                                                                      CERTIFICATE OF AUTHORITY 
                                   Secretary of Sta et
                                                                                                       (COOPERATIVE) 
                                             State of Iowa 
  
           TO THE SECRETARY OF STATE OF THE STATE OF IOWA: 
           Pursuant to section 1503 of the Iowa Business Corporation Act             , the undersigned corporation applies for a 
           certificate of authority to transact business in Iowa, and states: 
 
           1   . The name o  f the cooperative association is:                                                                    
           1A. [See note 6] The name the cooperative association will use in Iowa, if different than the legal name of the 
                 corporation is:                                                                                                  
 
           2   . The cooperative association is incorporated under the laws o  f t     he st ta e or f oreign count ryf o  :       
 
           3   . The date o f      incorporation o  f t he cooperat ive associat ion was:                                         
 
           4   . The duration o  f the cooperative association is:                                                                
 
           5.    The cooperative ownership is evidenced by: (check one)                                 
                                                                                                        
                                   membership without capital stock                                    capital stock 
 
           6.    The street address of its principal office is: 
                 Address                                                                                                           
                 City , State, Zip                                                                                                
 
           7.    The street address of its registered office in Iowa and the name of its registered agent at that office: 
 
                 Name                                                                                                             
                 Address                                                                                                           
                 City  , State  , Zip                                                                                             
 
           8.    The names and business addresses of its current directors and officers: 
 
                 Name                                                                 Position(s):                                
                 Address                                                                                                           
                 City  , State  , Zip                                                                                             
 
                 Name                                                                 Position(s):                                
                 Address                                                                                                           

                 City  , State  , Zip                                                                                             
 
                 Name                                                                 Position(s):                                
                 Address                                                                                                           
                 City  , State  , Zip                                                                                             
 
 635_0109 
 rev  1/15 

Name      Position(s):     
Address    
City, State, Zip     
 
Name    Position(s):    
Address     
City, State, Zip     
 
[Please attach additional pages as necessary] 
 
9.   A certificate of existence, or a document of similar import, duly authenticated within 90  
      days prior to the date of this application, by the secretary of state or other official having  
custody of corporate records in the state or country of incorporation, accompanies this 
application. 
 
10.  Signature    
 
    Type or print name and title     
 
NOTES: 
 
        1.  The filing fee is $100.00. Make checks payable to SECRETARY OF STATE. 
             2. A certificate of existence, or a document of similar import, duly authenticated within 90 days prior to the date
            of this application, by the secretary of state or other official having custody of corporate records in the state or
    country of incorporation, must accompany this application. 
             . 3  The document is to be signed by the chairperson of the board, the president, or other officer of the corpora-
             tion. If directors have not been selected, the document is to be signed by an incorporator. If the corporation
              is in the hands of a court appointed fiduciary, the document is to be signed by the fiduciary. A copy of a
        signature is acceptable for filing. Verification is not required. 
 
          . 4  One copy of the document is to be delivered to the Secretary of State for filing. 
 
           . 5  The effective time and date of the document is the later of the following: 
      . a  the time of filing on the date it is filed; 
        . b  the time specified in the document on the date it is filed; 
               . c  the time and date specified in the document, not later than 90 days after the date it is filed. 
 
               6. If the name of the cooperative association does not satisfy the requirements of Iowa Code section 499.40(1),
           the cooperative may do either of the following in applying for a certificate of authority: 
          . a add the word"cooperative "to its corporate name for use in Iowa: 
or 
   . b  use a fictitious name to transact business in Iowa if the cooperative association’s  real name
   is unavailable and the cooperative association delivers to the secretary of state for filing a
   copy of the resolution of its board of directors, certified by its secretary, adopting the fictitious
  name.  
 
             . 7  The information you provide will be open to public inspection under Iowa Code chapter 22.11. 
 
 SECRETARY OFSTATE
  Business Services Division
     Lucas Building, 1st Floor
     Des Moines, Iowa 50319 
 
    Phone:(515)281-5204
      Fax: (515)242-5953
   Website: sos.iowa.gov