Secretary of State Office NON-STOCK APPLICATION FOR 
500 E Capitol Ave 
Pierre, SD  57501                   AMENDED CERTIFICATE OF 
(605)773-4845                                         AUTHORITY
corpinfo@state.sd.us                FOREIGN NONPROFIT  ORPORATIONC               

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

1. The Name and Business ID of the corporation is:

Name (Note: This must be the exact corporate name as registered.)                  Business ID 

2. The Name of the corporation as amended:

3. The name of the state or other jurisdiction under whose laws it is incorporated:

4. The address of its principal office (this is the address of the executive offices of the company):

Street Address                                                             City    State             ZIP+4 

Mailing Address if different from street address                           City    State             ZIP+4 

Email Address (Optional) 

5. The South Dakota Registered Agent’s name:
South Dakota law permits the registered agent to be either: A) a noncommercial registered agent (this may be an
individual), B) a commercial registered agent, or C) an office holder.  Complete only one below, either (a) or (b) or (c).

(a) The South Dakota Noncommercial Registered Agent’s name:

Actual Street Address in this State                                    City        State             ZIP+4 

Mailing Address in this State, if Different from Street Address        City        State             ZIP+4 

Email Address (Optional) 

(b) When listing a Commercial Registered Agent, please state their CRA#. This number can be obtained from the
    Commercial Registered Agent.

Commercial Registered Agent Name                                                   CRA# 

(c) Title of the office or other position with the business:
                                                                                                      ____________ 
Business Office’s Actual Street Address in this State                  City        State             ZIP+4 

Mailing Address in this State, if Different from Street Address        City        State             ZIP+4 
 _____________________________________________________________________________________________________________________ 
Email Address (Optional)  

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6. The purpose(s) that the corporation is engaging in business in South Dakota:

7. The names and usual business addresses of its principal officers and directors. Place a check mark next to the name
if the principal officer serves as a director.
                                                                                                             ____________ 
President                         Street Address                            City                 State      ZIP+4 
                                                                                                             ____________ 
Vice President                    Street Address                            City                 State      ZIP+4 
                                                                                                             ____________ 
Secretary                         Street Address                            City                 State      ZIP+4 
                                                                                                             ____________ 
Treasurer                         Street Address                            City                 State      ZIP+4 
                                                                                                             ____________ 
Director                          Street Address                            City                 State      ZIP+4 
                                                                                                             ____________ 
Director                          Street Address                            City                 State      ZIP+4 
                                                                                                             ____________ 
Director                          Street Address                            City                 State      ZIP+4 

8. The foreign corporation shall deliver with the completed application an Original Certificate of Existence or a document
of similar import, duly authenticated by the Secretary of State or other official having custody of corporate records in the
state or other jurisdiction under whose law it is incorporated.

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

Dated 
                                                               Signature of an authorized person 

Email 
      (Optional)                                               Printed Name 

                                                               Title 

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                                                                            Foreignnonprofitamendedcertificateofauthority Feb 2018