Free RETURN TO - South Dakota

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

COMMERCIAL REGISTERED AGENT REGISTRATION
Please Type or Print Clearly in Ink

RECEIPT NO ___________________

Please submit one Original and one Photocopy

Clear Form
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CRA NUMBER __________________ The Commercial Registered Agent Number will be issued by the Secretary of State.

FILING FEE: $100 payable to SECRETARY OF STATE

The undersigned submits the following statement for the purpose of being listed as a Commercial Registered Agent in the State of South Dakota.

1. The name of the individual or entity __________________________________________________________________ 2. If an entity the jurisdiction of organization______________________________________________________________ 3. If an entity the type of entity ________________________________________________________________________ 4. The street address in South Dakota of the place of business to which service of process may be delivered ______________________________________________________________________________________________
Street Address (Required to be a South Dakota Address) City State ZIP+4

______________________________________________________________________________________________
Mailing Address (Optional ­ Required to be a South Dakota Address) City State ZIP+4

5. Optional statement regarding alternate means of accepting service of process

______________________________________________________________________________________________ The following information is not required. Any information provided will be available to the public on the Secretary of State's website at http://www.sdsos.gov/. 6. Phone number _________________ 7. Fax number _________________

8. E-mail address __________________________________________________________________________________ 9. Web address __________________________________________________________________________________

The above referenced individual or entity intends to be in the business of serving as a Commercial Registered Agent in the State of South Dakota. Dated ____________________________ ______________________________________________
(Signature of an authorized officer)

______________________________________________
(Printed Name)

______________________________________________
(Title) Commercialagentregistration July 2008