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                                                                                                  APPLICATION FOR 
                                         PAUL D. PATE 
                                                                                    CERTIFICATE OF AUTHORITY 
                                     Secretary of Staet
                                                                                                    (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 ofthe cooperaivet      associaiont is:                                                                 
          1A. [See note 6] The name the cooperative association will use in Iowa, if different than the legal name of the 
               corporaiont     is:                                                                                             
 
          2  . The cooperative associaiont     is incorporaedt    under het laws o heft s aet tor oreignf counry ot:   f        
 
          3  . The daet      ofincorporaiont o heft cooperaivet associaiontwas:                                                
 
          4  . The duraiont         ofthe cooperaivet associaiont 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                                                                                                          
               Ciyt ,State,  ip   Z                                                                                            
 
          7.   The street address of its registered office in Iowa and the name of its registered agent at that office: 
 
               Name                                                                                                            
               Address                                                                                                          
               Ciy t ,Stae t ,Zip                                                                                              
 
          8.   The names and business addresses of its current directors and officers: 
 
               Name                                                                 Position(s):                               
               Address                                                                                                          
               Ciy t ,Stae t ,Zip                                                                                              
 
               Name                                                                 Position(s):                               
               Address                                                                                                          

               Ciy t ,Stae t ,Zip                                                                                              
 
               Name                                                                 Position(s):                               
               Address                                                                                                          
               Ciy t ,Stae t ,Zip                                                                                              
 
 635_0109 
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      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 OF STATE 
                                      Business Services Division 
                                      Lucas Building, 1st Floor 
                                      Des Moines, Iowa 50319 
 
                                      Phone: (515) 281-5204 
                                      Fax: (515) 242-5953  
                                      Website: sos.iowa.gov 






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