Free - West Virginia

Natalie E. Tennant Secretary of State State Capitol Building 1900 Kanawha Blvd. East Charleston, WV 25305-0770 www.wvsos.com

Statement of Agent of Process for Unincorporated Non-ProfitAssociation

Penney Barker, Team Leader Corporations Division Tel: (304) 558-8000 Fax: (304)558-8381 Hrs: 8:30 am - 5:00 pm FILE ONEAPPLICATION FEE: $15 Ctrl # __ __ __ __ __

1 . The name of the Unincorporated Non-Profit Association shall be:

2. The principal office address of the
association will be:

Street: City/State/Zip:

located in the County of: The mailing address of the association, if different, will be:

County: Street/Box: City/State/Zip:

3. The name and address of the person to

Name: Street: City/State/Zip:

whom notice of process may be sent, in this state is:

4. Acknowledgement and Signatures:
This statement must be signed and acknowledged by a person authorized to manage the affairs of an unincorported nonprofit association. The statement must also be signed by the person appointed agent, who thereby accepts the appointment.

Signature of the appointed agent

Signature of applicant (authorized to act on behalf of company)

Name of Contact person and phone number of person to reach in case of problem with filing (optional)

Business and email address, if any CHARITABLE REGISTRATION: If your company receives contributions, donations or grants, registration as a charitable organization maybe required. Contact our office for more information or visit www.wvsos.com

FORM UNA-1

Issued by the WV Secretary of State, State Capitol, Charleston, WV 25305

Revised 1/09

CHARITABLE REGISTRATION: If your company receives contributions, donations or grants, registration as a charitable organization may be required. Contact our office for more information or visit www.wvsos.com
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