APPLICATION FOR
Secretary of State Office
500 E Capitol Ave
Pierre, SD 57501
(605)773-4845
CERTIFICATE OF TRUST
DOMESTIC BUSINESS TRUST
Please Type or Print Clearly in Ink
Please submit one Original and one Photocopy
FILING FEE: $125 payable to SECRETARY OF STATE
Telephone # ____________________
FAX # _______________________
Pursuant to the provisions of SDCL 47-14A, the undersigned business trust hereby submits a certificate of
trust:
1. The name of the Business Trust is __________________________________________________________________
______________________________________________________________________________________________
2. The name and the business address of at least one of the trustees meeting the requirements set forth in SDCL 47-14A
_______________________________________________________________________________________________
Trustee Business Address City State ZIP+4
3. The future effective date or time of effectiveness of the certificate if it is not to be effective upon the filing of the
certificate is __________________________, 20 _________.
4. Any other information the trustees determine to set forth:
A Certificate of Trust must be signed by all of the trustees. The execution of a certificate constitutes an oath or affirmation, under the
penalties of perjury, that, to the best of the trustee’s knowledge and belief, the facts stated therein are true (SDCL 47-14A-51).
Dated ____________________________ ______________________________________________
(Signature of a trustee)
______________________________________________
(Printed Name)
______________________________________________
(Title)
Dated ____________________________ ______________________________________________
(Signature of a trustee)
______________________________________________
(Printed Name)
______________________________________________
(Title)
domestictrust July 200
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