Free Foreign Application for Certificate of Authority to Transact Business - Nebraska

APPLICATION FOR CERTIFICATE OF AUTHORITY LIMITED COOPERATIVE ASSOCIATION
(FOREIGN) Submit in Duplicate

John A. Gale, Secretary of State Room 1301 State Capitol, P.O. Box 94608 Lincoln, NE 68509 (402) 471-4079
http://www.sos.state.ne.us An original certificate of good standing or existence from the state or country of organization executed by the official having custody of such records must be filed with this application. NOTE: A certified copy of the company's articles of organization may not be filed in lieu of a certificate of good standing or existence.

Name of Limited Cooperative Association __________________________________ _____________________________________________________________________ Alternative Name ______________________________________________________ (only used when the associations name does not comply with Neb. Rev. Stat. 21-2908) Organized under the laws of the State/Jurisdiction of _________________________ Address of Designated office in this state: ____________________________________________________NE_________________
Street and Mailing Address City State Zip

Address of Designated office in state of organization IF such address is required by state of organization: _____________________________________________________________________
Street and Mailing Address City State Zip

Name and address of registered agent in Nebraska: Registered Agent Name:__________________________________________________ Address: _____________________________________________NE______________
Street and Mailing Address City Zip

____________________________________
Signature of Officer or Authorized Representative

_________________________________
Printed name of Officer or Authorized Representative

FILING FEE: For Profit $145.00 plus $5.00 per page for any additional pages Not for Profit $25.00 plus $5.00 per page for any additional pages
1/1/2008 103 Neb. Rev. Stat.21-29,

OFFICERS:
_________________________________________ Name/Title _________________________________________ Street and Mailing Address _________________________________________ Name/Title _________________________________________ Street and Mailing Address _________________________________________ Name/Title _________________________________________ Street and Mailing Address _________________________________________ Name/Title _________________________________________ Street and Mailing Address _________________________________________ Name/Title _________________________________________ Street and Mailing Address _________________________________________ Name/Title _________________________________________ Street and Mailing Address _________________________________________ Name/Title _________________________________________ Street and Mailing Address _________________________________________ Name/Title _________________________________________ Street and Mailing Address _________________________________________ Name/Title _________________________________________ Street and Mailing Address

DIRECTORS:
________________________________________ Name ________________________________________ Street and Mailing Address ________________________________________ Name ________________________________________ Street and Mailing Address ________________________________________ Name ________________________________________ Street and Mailing Address ________________________________________ Name ________________________________________ Street and Mailing Address ________________________________________ Name ________________________________________ Street and Mailing Address ________________________________________ Name ________________________________________ Street and Mailing Address ________________________________________ Name ________________________________________ Street and Mailing Address ________________________________________ Name ________________________________________ Street and Mailing Address ________________________________________ Name ________________________________________ Street and Mailing Address

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