Form Una-1 - Statement Of Agent Of Process For Unincorporated Non-Profit Association - 2013
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1Natalie E. Tennant
Penney Barker, Manager
Secretary of State
Corporations Division
1900 Kanawha Blvd E
Tel: (304)558-8000
Bldg 1, Suite 157-K
Fax: (304)558-8381
Charleston, WV 25305
Website:
E-mail:
STATEMENT OF AGENT OF
FILE ONE ORIGINAL
Office Hours: Monday – Friday
PROCESS FOR UNINCORPORATED
8:30 a.m. – 5:00 p.m. ET
(Two if you want a filed
ASSOCIATION
NON-PROFIT
stamped copy returned to you)
FEE: $15.00
Control #________________
1. The name of the Unincorporated
Non-Profit Association shall be:
____________________________________________________
2. The principal office address of the
__________________________________
Street:
association will be:
City/State/Zip: _______________________________________
located in the County of:
County:
_______________________________________
The mailing address of the association,
Street/Box:
_______________________________________
if different, will be:
City/State/Zip: _______________________________________
3. The name and address of the person to
Name:
_______________________________________
whom notice of process may be sent
in West Virginia is:
Street:
_______________________________________
City/State/Zip: _______________________________________
4. Contact name and number of person to reach in case of problem with filing:
(Optional, however,
listing one may help to avoid a return or rejection of filing if there appears to be a problem with the document.)
Name: ______________________________________ Phone: ____________________________
Business e-mail address, if any: ______________________________________________________
5. Acknowledgement and Signatures* (
This statement must be signed and acknowledged by a person authorized
to manage the affairs of an unincorporated non-profit association. The statement must also be signed by the person
:
appointed must also be signed by the person appointed agent, who thereby accepts the appointment.)
Signature of Appointed Agent: _______________________________________
Signature of Applicant
: _______________________________
(authorized to act on behalf of company)
*Important Legal Notice Regarding Signature: Per West Virginia Code §31D-1-129. Penalty for signing false
document. Any person who signs a document he or she knows is false in any material respect and knows that the document
is to be delivered to the Secretary of State for filing is guilty of a misdemeanor and, upon conviction thereof, shall be fined
not more than one thousand dollars or confined in the county or regional jail not more than one year, or both.
CHARITABLE REGISTRATION: If your company receives contributions, donations or grants,
registration as a charitable organization may be required. Contact our office for more information or
visit our website at .
Form UNA-1
Issued by the Office of the Secretary of State
Revised 5/13
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