Free SECRETARY OF STATE - South Dakota

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

APPLICATION FOR RESERVATION OF NAME
NONPROFIT CORPORATION
Please Type or Print Clearly in Ink

Clear Form
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Please submit one Original and one Photocopy

FILING FEE: $25 payable to SECRETARY OF STATE
Telephone # ____________________ FAX # _______________________

Pursuant to the provisions of the South Dakota Law, the undersigned hereby applies for reservation of the following name for a period of one hundred twenty (120) days, which period shall not be extended.
1. The name to be reserved is _______________________________________________________________________ ______________________________________________________________________________________________

2. Check one to indicate how the reserved name is to be used: Incorporation of a domestic nonprofit corporation Domestic nonprofit corporation intending to change its name

Foreign nonprofit corporation intending to make application for a Certificate of Authority Foreign nonprofit corporation authorized in this state intending to change its name Any person intending to organize a foreign nonprofit corporation and to have such corporation make application for a Certificate of Authority

Dated ____________________________

______________________________________________
(Signature of the applicant)

______________________________________________
(Printed Name)

______________________________________________
(Title)

______________________________________________
(Address)

______________________________________________
(City) (State) (ZIP+4)

reservationofnonprofitname July 2009