Secretary of State Office              NON-STOCK APPLICATION FOR 
500 E Capitol Ave 
Pierre, SD  57501                      CERTIFICATE OF AUTHORITY
(605)773-4845                                       FOREIGN NONPROFIT  ORPORATIONC            
                                                                   SDCL 47-27-1 
corpinfo@state.sd.us
                                                         FILING FEE: $125 
                                                     Make check payable to SECRETARY OF STATE

Application must be accompanied by a one page Original Certificate of Existence issued 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.

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 incorporation:

4. The period of duration of corporation:

5. The address of its principal office (this is the address of the office of the corporation in the state or country under whose
   laws it is incorporated):

   Street Address                                                          City               State ZIP+4 

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

   Email Address (Optional) 

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

8. 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 

9. 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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                                                                                 Foreignnonprofitcertificateofauthority Feb 2018