Application For Amended Certificate Of Authority (Nonprofit) {635_0103}

PAUL D. PATE Secretary of State State of Iowa APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY (NONPROFIT) TO THE SECRETARY OF STATE OF THE STATE OF IOWA: Pursuant to section 1504 of the Revised Iowa Nonprofit Corporation Act, the undersigned corporation applies to amend its certificate of authority to transact business in Iowa, and states: 1. The name of the corporation is: and the name the corporation uses in Iowa if different than its real name is: [If applicable] The name the corporation has been changed to is: 2. The corporation is incorporated under the laws of the state [or foreign country] of: 3. The date of incorporation of the corporation was: 4. The duration of the corporation is: 5. The street address of its principal office is: Address City, State, Zip 6. The street address of its registered office in Iowa and the name of its registered agent at that office: Name Address City, State, Zip 7. Check one: The corporation has members. The corporation has no members. 8. The names and usual business or home addresses of its current directors and officers Name Address City, State, Zip Name Address City, State, Zip 635_0103 1/15 American LegalNet, Inc. www.FormsWorkFlow.com Name Address City, State, Zip Name Address City, State, Zip [Please attach additional pages as necessary] 9. A certificate of existence, or a document of similar import, duly authenticated within 90 days prior to the date of this application, by the secretary of state or other official having custody of corporate records in the state or country of incorporation, accompanies this application. 10. Signature Type or print name and title NOTES: 1. The filing fee is $25.00. Make checks payable to SECRETARY OF STATE. 2. A certificate of existence, or a document of similar import, duly authenticated within 90 days prior to the date of this application, by the secretary of state or other official having custody of corporate records in the state or country of incorporation, must accompany this application. 3. The document is to be signed by the chairperson of the board, the president, or other officer of the corporation. If directors have not been selected, the document is to be signed by an incorporator. If the corporation is in the hands of a court appointed fiduciary, the document is to be signed by the fiduciary. A copy of a signature is acceptable for filing. Verification is not required. 4. One copy of the document is to be delivered to the Secretary of State for filing. 5. The effective time and date of the document is the later of the following: a. the time of filing on the date it is filed; b. the time specified in the document on the date it is filed; c. the time and date specified in the document, not later than 90 days after the date it is filed. 6. The information you provide will be open to public inspection under Iowa Code chapter 22.11. SECRETARY OF STATE Business Services Division Lucas Building, 1st Floor Des Moines, IA 50319 Phone: (515) 281-5204 Fax: (515) 242-5953 Website: sos.iowa.gov American LegalNet, Inc. www.FormsWorkFlow.com