Secretary of State Office                          
500 E Capitol Ave                      APPLICATION FOR 
Pierre, SD 57501 
(605)773-4845                    REGISTRATION OF NAME 
corpinfo@state.sd.us            FOREIGN LIMITED  IABILITY L   OMPANYC            
                                        SDCL 47-34A-107, 1005 

                                       FILING FEE: $25 
                                 Make check payable to SECRETARY OF STATE

Pursuant to the provisions of South Dakota law, the undersigned Limited Liability Company hereby applies for 
the registration of its name to and including December 31,     , and submits the following: 

1. The name of the company:

2. The name of the state or other jurisdiction under whose laws it is organized:

3. The date of its organization:

4. The business in which it is engaged:

5. This application is accompanied by an original Certificate of Existence executed by the Secretary of
   State or other official having custody of the organizational records in the state or other jurisdiction under whose
   law it is organized.

6. This application does not qualify the LLC to conduct business in South Dakota.

The registration is effective until the close of the calendar year in which the application for registration is filed. 

A renewal application may be filed between the first day of October and the thirty-first day of December each year, and shall 
extend the registration for the following calendar year. 

No person may execute this report knowing it is false in any material respect.  Any violation may be subject to a criminal 
penalty (SDCL 22-39-36). 

Dated 
                                                         Signature of an authorized person 

Email 
      (Optional)                                         Printed Name 

                                                         Title 

                                                                                           Foreignllcnameregistration Feb 2018