Secretary of State Office                          
500 E Capitol Ave                      APPLICATION FOR 
Pierre, SD 57501 
(605)773-4845                    REGISTRATION OF NAME 
corpinfo@state.sd.us             FOREIGN BUSINESS  ORPORATIONC            
                                             SDCL 47-1A-403 

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

1. The name of the corporation:

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

3. The date of its incorporation:

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 corporate records in the state or other jurisdiction under whose law it
   is incorporated.

6. This application does not qualify the corporation 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. 

Application must be signed by an authorized officer of the corporation. 

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 47-1A-129; 22-39-36). 

Dated 
                                                            Signature of an authorized person 

Email 
      (Optional)                                            Printed Name 

                                                            Title 

                                                                                              Foreignnameregistration Feb 2018