Free 635_0120.p65 - Iowa

MICHAEL A. MAURO Secretary of State State of Iowa

Application for Renewal of Registration of Corporate Name

Pursuant to Iowa law, the business entity applies for a renewal of the registration of its name for the calendar year and states: 1. 2. The name of the business entity is The state or foreign country in which the business entity is incorporated/formed is:

3. 4.

The date of its incorporation/formation is A brief description of the nature of the business in which the entity is engaged is:

5.

A certificate of existence, or a document of similar import, from the state or country of incorporation/formation accompanies this application.

Signature Type or print name and title

Date

NOTES: 1. The filing fee is $20.00. Make checks payable to SECRETARY OF STATE 2. The application is to be signed by the chairperson of the board of directors, the president, or another officer of the corporation. It must also state the person's name and the capacity in which the person signed. 3. One copy of the document is to be delivered to the Secretary of State for filing. 4. The renewal application is to be filed between October 1 and December 31 of the calendar year to which the renewal applies. 5. The information you provide will be open for public inspection under Iowa Code section 22.11.

SECRETARY OF STATE Business Services Division Lucas Building, 1st Floor Des Moines, Iowa 50319 Phone: (515) 281-5204 FAX: (515) 281-7142 or (515) 242-5953 Website: www.sos.state.ia.us

635_0120 6/09