Secretary of State Office 500 E Capitol Ave Pierre, SD 57501 (605)773-4845
APPLICATION FOR CERTIFICATE OF TRUST
DOMESTIC BUSINESS TRUST
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FILING FEE: $125 payable to SECRETARY OF STATE
Telephone # ____________________ FAX # _______________________
Pursuant to the provisions of SDCL 47-14A, the undersigned business trust hereby submits a certificate of trust:
1. The name of the Business Trust is __________________________________________________________________ ______________________________________________________________________________________________ 2. The name and the business address of at least one of the trustees meeting the requirements set forth in SDCL 47-14A _______________________________________________________________________________________________
Trustee Business Address City State ZIP+4
3. The future effective date or time of effectiveness of the certificate if it is not to be effective upon the filing of the certificate is __________________________, 20 _________. 4. Any other information the trustees determine to set forth:
A Certificate of Trust must be signed by all of the trustees. The execution of a certificate constitutes an oath or affirmation, under the penalties of perjury, that, to the best of the trustee's knowledge and belief, the facts stated therein are true (SDCL 47-14A-51).
Dated ____________________________
______________________________________________
(Signature of a trustee)
______________________________________________
(Printed Name)
______________________________________________
(Title)
Dated ____________________________
______________________________________________
(Signature of a trustee)
______________________________________________
(Printed Name)
______________________________________________
(Title) domestictrust July 2009