Secretary of State Office                               
500 E Capitol Ave         APPLICATION FOR RENEWAL 
Pierre, SD 57501 
(605)773-4845                    OF REGISTERED NAME 
corpinfo@state.sd.us             FOREIGN BUSINESS  ORPORATIONC
                                             SDCL 47-1A-403.1 

                                  FILING FEE: $15 
                                 Make check payable to SECRETARY OF STATE

RENEWAL DATE:   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. 

Pursuant to the provisions of South Dakota law, the undersigned corporation hereby applies for the renewal of the 
registration of its name, and submits the following statements: 

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. It is carrying on or doing business. 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.

The 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 

                                                                             Foreignnameregistrationrenewal  Feb 2018