Free SECRETARY OF STATE - South Dakota

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

APPLICATION FOR REINSTATEMENT
DOMESTIC COOPERATIVE
Please Type or Print Clearly in Ink

Clear Form

Please submit one Original and one Photocopy

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FILING FEE: $300 payable to SECRETARY OF STATE
Telephone # ____________________ FAX # _______________________

1. The name of the cooperative is ____________________________________________________________________ ______________________________________________________________________________________________
Note: This must be the exact cooperative name.

2. The effective date of its administrative dissolution ______________________________________________________

Any cooperative administratively dissolved may apply to the secretary of state for reinstatement within 2 years after the effective date of dissolution.
3. State that the ground or grounds for dissolution either did not exist, or 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.

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
domesticcooperativereinstartment July 2009