Nonstock Application For Amended Certificate Of Authority Form
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1
2Secretary of State
State Capitol
500 E. Capitol Ave.
Clear Form
Pierre SD 57501
Phone 605-773-4845
Fax 605-773-4550
Print
Nonstock
Application for Amended Certificate of Authority
Pursuant to the provisions of SDCL 47-27-17, the undersigned corporation hereby applies for an amended Certificate of Authority to
transact business in the State of South Dakota and for that purpose submits the following statement:
(1) The name of the corporation is _______________________________________________________________________________
(exact corporate name)
___________________________________________________________________________________________________________
(2) The name of the corporation as amended is _____________________________________________________________________
___________________________________________________________________________________________________________
(3) State where incorporated ________________________________________ Federal Taxpayer ID# _________________________
(4) The date of its incorporation is _______________________ and the period of its duration is ______________________________
(5) The address of its principal office in the state or country under the laws of which it is incorporated is
___________________________________________________________________________________Zip Code ________________
mailing address if different from above is: _________________________________________________________________________
____________________________________________________________________________________Zip Code _______________
(6) The street address, or a statement that there is no street address, of its proposed registered office in the State of South Dakota is
____________________________________________________________________________________Zip Code _______________
and the name of its proposed registered agent in the State of South Dakota at that address is ________________________________.
(7) The purposes which it proposes to pursue in the transaction of business in the State of South Dakota are:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
(8) The names and respective addresses of its directors and officers are:
Name
Officer Title
Street Address
City
State
Zip
____________________________________
________________ __________________________________________________
____________________________________
________________ __________________________________________________
____________________________________
________________ __________________________________________________
____________________________________
________________ __________________________________________________
____________________________________
________________ __________________________________________________
____________________________________
________________ __________________________________________________
____________________________________
________________ __________________________________________________
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