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STATE OF SOUTH CAROLINA SECRETARY OF STATE ADOPTION OF A FICTITIOUS NAME Nonprofit Corporation - Foreign Filing Fee - $10.00 TYPE OR PRINT CLEARLY IN BLACK INK Pursuant to S.C. Code of Laws §33-31-1506, the undersigned nonprofit corporation submits the following: 1. Applicant's name (individual submitting form) _________________________________________________ 2. The legal name of the nonprofit corporation is __________________________________________________ 3. Enter the date that the Board of Directors adopted the resolution to use the fictitious name _______________ 4. Enter the fictitious name that the Board of Directors adopted to use for conducting business in the state of South Carolina ___________________________________________________________________________ 5. By signing and submitting this form you are affirming that the Board of Directors of the nonprofit corporation duly adopted the resolution to use a fictitious name in South Carolina for conducting all business at a duly called meeting of the Board. A quorum was present for the meeting and the resolution was set forth in the minutes of the meeting. Additionally, you are the keeper of the corporate seal and of the minutes and records of the nonprofit corporation and the said resolution has not been rescinded or modified. Date ______________________ ____________________________________________ Signature ____________________________________________ Print Name ____________________________________________ Title Filing Checklist Fictitious Name Form (filed in duplicate) $10.00 made payable to the South Carolina Secretary of State Make sure the proper person has signed the document
Documents filed with the Secretary of State should be executed by: (1) the Presiding Officer of its Board of Directors of a domestic or foreign corporation, its president or another of its officers (2) if directors have not been selected or the corporation has not been formed, by an incorporator; or (3) if the corporation is in the hands of a receiver, trustee or other court appointed fiduciary, by that fiduciary.



Self-Addressed, Stamped Return Envelope Return all documents to: South Carolina Secretary of State's Office Attn: Corporate Filings P.O. Box 11350 Columbia, SC 29211

NP ­ Foreign ­ Fictitious Name Form

Form Revised by South Carolina Secretary of State, July 2007