Wyoming Secretary of State Phone (307) 777-7311/7312 The ...

1 APPLICATION FOR CERTIFICATE OF DOMESTICATIONARTICLES OF DOMESTICATIONW yoming Secretary of StatePhone (307) 777-7311/7312 The Capitol Building, Room 110 Fax (307) 777-5339200 W. 24th StreetE-mail: WY 82002-0020 Pursuant to the 17-19-1702 of the Wyoming Nonprofit Corporation Act, the undersigned herebyapplies for a Certificate of Domestication and for that purpose hereby submits Articles of name of the corporation is: is incorporated under the laws of: date of its incorporation is: _____and the period of its duration is.

2 Address of its principal office and the jurisdiction under the laws of which it is incorporated mailing address where correspondence and annual reports can be physical address of its proposed registered office in Wyoming and name of its registered agentat that address is: _____(The agent must be an individual who resides in this State , a domestic corporation or a not-for-profit domesticcorporation or a foreign corporation or not-for-profit foreign corporation authorized to transact business in thisstate.) purpose or purposes of the corporation which it proposes to pursue in the transaction of businessin this names and respective addresses of its officers and directors are:OfficeNameAddressPresident _____Vice-President _____Secretary _____Treasurer _____Director _____Director _____Director _____(If additional directors, attach list.)

3 Corporation is a public benefit corporation,mutual benefit corporation, or religious corporation (check appropriate line). corporation has members: _____ (Yes or No). corporation accepts the constitution of the State of Wyoming in compliance with therequirement of article 10, section 5 of the Wyoming : _____Signed: _____ Title: _____(May be executed by Chairman of Board, President or anotherof its officers)**Filing Fee: $ following documents must accompany the certified copy of its original articles of incorporation and all amendments theretoor its equivalent basic corporate charter or other authorization, currently certifiedwithin six original certificate of good standing not more than thirty (30) days written consent to appointment manually signed by the registered - Revised: 9/2003