Fillable Foreigncooperativecertificateofauthority20180215 RETURN TO

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Foreigncooperativecertificateofauthority20180215 RETURN TO

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Page 1 of 3
Secretary of State Office
500 E Capitol Ave
Pierre, SD 57501
(605)773-4845
corpinfo@state.sd.us
1. The Name of the Cooperative:
2. The name of the state or other jurisdiction under whose laws it is incorporated:
3. The date of incorporation:
4. The period of duration of incorporation:
5. The address of its principal office (this is the address of the executive offices of the company):
Street Address
City State
ZIP+4
Mailing Address if different from street address
City State
ZIP+4
Email Address (Optional)
6.
The South Dakota Registered Agent’s name:
South Dakota law permits the registered agent to be either: A) noncommercial registered agent (this may be an
individual), B) a commercial registered agent, or C) an office holder. Complete only one below, either (a) or (b) or (c).
(a) The South Dakota Noncommercial Registered Agent’s name
Actual Street Address in this State City State ZIP+4
Mailing Address in this State, if Different from Street Address City State ZIP+4
Email Address (Optional)
(b) When listing a Commercial Registered Agent, please state their CRA#. This number can be obtained from the
Commercial Registered Agent.
Commercial Registered Agent Name CRA#
(c) Title of the office or other position with the business
Business Office’s Actual Street Address in this State City State ZIP+4
Mailing Address in this State, if Different from Street Address City State ZIP+4
Email Address (Optional)
APPLICATION FOR
CERTIFICATE OF AUTHORITY
FOREIGN COOPERATIVE
SDCL 47-19-2
FILING FEE: $750
Make check payable to SECRETARY OF STATE
Page 2 of 3
7. The purpose(s) that the corporation is engaging in business in South Dakota:
8. The names and usual business addresses of its current officers and directors. Place a check mark next to the name if
the principal officer serves as a director.
____________
President Street Address City State ZIP+4
____________
Vice President Street Address City State ZIP+4
____________
Secretary Street Address City State ZIP+4
____________
Treasurer Street Address City State ZIP+4
____________
Director Street Address City State ZIP+4
____________
Director Street Address City State ZIP+4
____________
Director Street Address City State ZIP+4
9. The aggregate number of members and class of those members, if any:
Number of Members Class
10. The aggr
egate number of shares which it has authority to issue, itemized by classes, par value of shares, shares
without par value, and series, if any, within a class:
Number of Shares Class Series Par value per share or Statement that shares are without par value
11. The aggr
egate number of shares issued which it has authority to issue, itemized by classes, par value of shares,
shares without par value, and series, if any, within a class is:
Number of Shares Class Series Par value per share or Statement that shares are without par value
Page 3 of 3
Foreigncooperativecertificateofauthority Feb 2018
12. Such additional information as may be necessary in order to enable the secretary of state to determine whether such
c
ooperative is entitled to a certificate of authority.
13. The foreign corporation shall deliver with the completed application an Original Certificate of Existence or a
doc
ument of similar import, duly authenticated by the Secretary of State or other official having custody of corporat
e
r
ecords in the state or other jurisdiction under whose law it is incorporated.
No person may execute this report knowing it is false in any material respect. Any violation may be subject to a civil
and/or criminal penalty (SDCL 47-1A-129; 22-39-36).
Dated
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Title
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Completed 4 July 2020

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