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                                                                               APPLICATION FOR 
                              PAUL D. PATE 
                                                                                      AMEND DE           
                        Secretary of Staet                      CERTIFICATE OF AU H RT O ITY                         

                                 State ofIowa                                  (NONPROFIT) 
 
  TO THE SECRETARY OF STATE OF THE STATE OF IOWA: 
  Pursuant tosection 1504  theof Revised IowaNonprofit CorporationAct, theundersigned corporationapplies to 
  amend its certificate of authority to transact business in Iowa, and states: 
 
    1.    Thenameofthecorporationis:                                                                               
 
        and the name the corporation uses in Iowa if different than its real name is: 

        [If applicable] The name the corporation has been changed to is: 

  2.   The state [or foreign country] of incorporation on the records of the Secretary of State of Iowa is:        
    
        The state [or foreign country] of incorporation has been changed to: ______________________________       
 
  3.    Thedateofincorporationofthecorporationwas:                                                                 
 
  4.    Thedurationofthecorporationis:                                                                             
  
          The duration has been changed to:  _________________________________________________________ 

  5.    The street address of its principal office is: 
        Address                                                                                                    
        City, State,Zip                                                                                            
 
  6.    The street address of its registered office in Iowa and the name of its registered agent at that office: 
 
        Name                                                                                                       
        Address                                                                                                     
        City, State,Zip                                                                                            
 
  7.    Check one:         The corporation has members.           The corporation has no members. 
 
  8.    The names and usual business or home addresses of its current directors and officers 
 
        Name                                                                                                       
        Address                                                                                                    
        City, State,Zip                                                                                            
 
        Name                                                                                                       
        Address                                                                                                     
        City, State,Zip                                                                                            
  635_0103 
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     Name                                                                                                             
     Address                                                                                                           
     City, State,Zip                                                                                                  
 
     Name                                                                                                             
     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                                                                                       
 
     Typeorprintnameandtitle                                                                          
 
 NOTES: 
 
 1.   The filing fee is $25.00. 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 thesecretary of state orotherofficial havingcustodyof 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 corporation. 
     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.   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, IA 50319 
 
                                               Phone:(515)281-5204         
                                                   Fax:(515)242-5953      
                                               Website: sos.iowa.gov 






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