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Application For Reinstatement Of Certificate Of Authority Foreign Non-Profit Corporation - Government Of The District Of Columbia

DEPARTMENT OF CONSUMER AND REGULATORY AFFAIRS

BUSINESS REGULATION ADMINISTRATION

CORPORATIONS DIVISION

Government

941 NORTH CAPITOL STREET, N.E.

WASHINGTON, D.C. 20002

of the

District of Columbia

APPLICATION FOR REINSTATEMENT OF CERTIFICATE OF AUTHORITY

FOREIGN NON-PROFIT CORPORATION

To:

Department of Consumer and Regulatory Affairs

Business Regulation Administration

Corporations Division

941 North Capitol Street, N.E.

Washington, D.C. 20002

Pursuant to the provisions of the Code of Laws for the District of Columbia and the NON-PROFIT

CORPORATION ACT (D.C. Code, 1981 edition, Title 29, Chapter 5), the undersigned corporation

hereby applies for a Certificate of Authority to conduct its affairs in the District of Columbia, and for that

purpose states as follows:

1. Name of Corporation: _______________________________________________________

2. Incorporated under the laws of the State/County of : _________________________________

3. Date of Incorporation: _______________________________________________________

4. Term of Existence (Perpetual or Specified Period): __________________________________

5. Date commenced or will commence conducting affairs in the District: _____________________

6. Address (including street and number) of its principal office in the State/County where organized:

___________________________________________________________________________

7. Address (including street and number) of its current registered office in the District:

___________________________________________________________________________

8. Name of its current registered agent at such registered office: ___________________________

9. Brief statement of activities it proposes to conduct in the District: ________________________

___________________________________________________________________________

10. Names and addresses (including streets and numbers) of its officers and directors:

Note: Include all officers and directors. If more space is required, attach an additional sheet.

President Name _______________________________________________________________

Application For Reinstatement Of Certificate Of Authority Foreign Non-Profit Corporation - Government Of The District Of Columbia