Unincorporated Nonprofit Association Appointment Of Agent {113-C}

State of Wisconsin DEPARTMENT OF FINANCIAL INSTITUTIONS Division of Corporate & Consumer Services F ILING FEE $15 .00 Please check box for (Optional) Expedited service + $25.00 DO NOT STAPLE DFI/CORP/113-C (04/18) Use of this form is mandatory. 1 FORM 1 13 - C APPOI NTMENT OF AGENT UNINCOR PORATED NONPROFIT ASSOCIATION Sec. 184.10 Wis. Stats. 1 . Name of the a ssociation : or end with th 2 . A ddress of the association, including street name and number, city, state and zip code: 3 . Name of registered agent : 4 . Street address of registered office in Wisconsin : 4. The person named in this statement has accepted the appointment to act as agent to receive service of process on behalf of the association. 5. Check the box below if this statement amends a previously filed appointment of agent to receive service of process. This statement supersedes and takes the place of any original, amended or restated statement previously filed. 6. Date: (Signature) Title: , Authorized person Office Use Only American LegalNet, Inc. www.FormsWorkFlow.com DFI/CORP/113-C (04/18) Use of this form is mandatory. 2 APPOINTMENT OF AGENT - UNINCORPORATED NONPROFIT ASSOCIATION Please provide an email or postal mailing address for the filed copy of the document. Your phone number during the day: INSTRUCTIONS Please use BLACK Ink. Submit statement to State of WI Dept. of Financial Institutions, Box 93348, Milwaukee WI, 53293-0348, together with a $15 FILING FEE, payable to Dept. of Financial Institutions. Filing fee is non-refundable. (If sent by Express or Priority U.S. mail, please visit www.wdfi.org/contactus/ for current physical address) NOTICE: This form may be used to accomplish a filing required or permitted by statute to be made with the department. Information requested may be used for secondary purposes. If you have any questions, please contact the Division of Corporate & Consumer Services at 608-261-7577. Hearing-impaired may call 711 for TTY. Sec. 184.10, Wis. Stats., provides that an unincorporated nonprofit association may appoint a person as agent to receive service of process by filing a statement with the Department of Financial Institutions, using the form prescribed by the department. 1. Enter the name of the unincorporated nonprofit association. 2. Provide the address of the association, including street and number, if any. The address may be in Wisconsin or elsewhere. 3. Provide the name and address of the person designated by the association to receive service of city in Wisconsin, and ZIP code. 4. This association must affirm that the registered agent has accepted the appointment to act as to receive service of process on behalf of the association. 5. If the statement is amending a statement previously filed, indicate that by marking (X) this item. 6. Enter the date the statement is signed, the title of the signer, and a signature. The statement is to be signed by a person who is authorized to manage the affairs of the unincorporated nonprofit association. This form is not appropriate for use by an incorporated association. If the association is the statutory chapter under which it is organized. American LegalNet, Inc. www.FormsWorkFlow.com