Fill and Sign the To the Secretary of State of the State of Iowa Form

MAT T S CHU L TZ Sec retary of St a te State of Iow a A PPL ICATION FO R C E R TIFI CA TE OF AU T H O R ITY TO THE SEC RETARY OF STAT E OF THE STAT E OF IOWA : Pu rsuant to s ection 1503 of the Iowa B usiness Corpora tion Act, th e undersigned c orporation applies for a certificat e of authorit y to transac t busi ness in Iowa, an d states: 1 . The name o f the c orpora tion is : 1A. [Se e not e 6] Th e nam e th e corporat ion will us e in Io wa, if differen t than the leg al nam e of the corporat ion is: 2. The corpora tion is incorpora ted under the l aws o f the s tate [or forei gn co un try] of: 3. The da te o f incorpora tion o f the c orpora tion w as : 4. The dura tion o f the corpora tion is : 5. The street address of its principa l offic e is: Addres s Ci ty, State, Zi p 6. The stree t addr ess of its registered office in Iowa an d th e nam e of its regi stere d agent at that offic e: Nam e Addres s City, State. Zip 7. The nam es and busines s addre sses of its c urrent directors and office rs: Nam e Addres s City, State, Zip Name Addres s City, State, Zip Name Addres s City, State, Zip 635_0110 A 12/12 Name Addres s City, State, Zip Nam e Addres s City, State, Zip [Please attac h additional pages as necessar y ] 8. A certificate of existence, or a document of similar import, duly authenticated within 90 days prior to the date of this application, by the s ecretary of state or other official having custody of corporate records in the state or country of incorporation, accompanies this application. 9. Signa ture Typ e or prin t nam e an d title NOTE S: 1. Th e fili ng fee is $100.00. Mak e check s payable to SECRETAR Y OF STAT E 2. A certificate of existence, or a document of similar import, duly authenticated within 90 days prior to the date of this application, by the s ecretary of state or other official having custody of corporate records in the state or country of incorporation, must accompan y this application. 3 . The document is to be signed by the chairperson of the board , th e president , or other officer of the corpor a- tion . If director s hav e no t been selected , th e document is to be signed by an incorporator . If the corporati on is in the hand s of a court appointe d fiduciary , th e document is to be signed by the fiduciary . A copy of a signatur e is acceptabl e fo r fili ng. Verificatio n is not requir ed. 4. On e cop y of the document is to be delivered to the Secretar y of State fo r filin g. 5. The effectiv e tim e and date of the document is the later of the followin g: a . the tim e of filing on the dat e it is filed; b . the tim e specifie d in the document on the dat e it is filed; c . the tim e an d dat e specifie d in the document , no t late r tha n 90 days afte r th e dat e it is filed. 6. If the nam e of the corporatio n does not satisf y th e requirement s of section 401 of the Iow a Busines s Corpora tion Act , th e corporation may do eithe r of the followin g in applying for a certificat e of au thori ty: a . add on e of the followin g words or abbreviation s to its corporat e nam e fo r us e in Iowa : corporation , incorporated , company , limited , corp. , inc. , co. , ltd. ; or b . use a fictitiou s nam e to transac t busines s in Iowa if the corpor ation' s real nam e is unavailable an d th e corporation delivers to the secretar y of state fo r filin g a cop y of the resolutio n of its boar d of director s, certifie d by its secretary , adoptin g the fictitiou s nam e. 7 . The information you provide will be ope n to publ ic inspectio n under Iow a Cod e chapte r 22.11 . SECRETARY OF STATE Business Services Division Lucas Building, 1st Floor Des Moines, Iowa 50319 635_0110 A 12/12 Phone : (515) 281- 5204 Fax : ( 515) 242- 5953 Website: sos.iowa.gov