Free SECRETARY OF STATE - South Dakota

Secretary of State Office 500 E Capitol Ave Pierre, SD 57501 (605)773-4845

APPLICATION FOR REINSTATEMENT
DOMESTIC NON-PROFIT CORPORATION
Please Type or Print Clearly in Ink

Clear Form

Please submit one Original and one Photocopy

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FILING FEE: $30 payable to SECRETARY OF STATE
Telephone # ____________________ FAX # _______________________

1. The name of the corporation is _____________________________________________________________________ ______________________________________________________________________________________________
Note: This must be the exact corporate name.

2. The effective date of its administrative dissolution ______________________________________________________ 3. The grounds for administrative dissolution have been eliminated by filing all required reports and paying all fees and penalties. 4. Attached hereto are ALL delinquent annual reports and filing fees. Application must be signed by the Chairman of the Board of Directors, the President, or any other officer in the presence of a notary public.

Dated ____________________________

______________________________________________
(Signature of an authorized officer)

______________________________________________
(Printed Name)

______________________________________________
(Title)

STATE OF _____________________________ COUNTY OF ___________________________ On this the ___________ day of _________________________, 20 ____ before me personally appeared ____________________________________________________________ known to me or satisfactorily proven to be the person who is described in, and who executed the within instrument and acknowledged to me that she/he/they executed the same. _________________________________ My Commission Expires ______________________________________________ Notary Public

Notarial Seal
domesticapplicationreinstartment July 2009