Form 170304 Certificate of Revival for a Nevada Nonprofit Corporation (For Nonprofit Corporations Governed by Nrs Chapters 81 (Except 81.010) and 82) - Nevada

Form 170304 or the "Certificate Of Revival For A Nevada Nonprofit Corporation (for Nonprofit Corporations Governed By Nrs Chapters 81 (except 81.010) And 82)" is a form issued by the Nevada Secretary of State.

The form was last revised in January 5, 2015 and is available for digital filing. Download an up-to-date Form 170304 in PDF-format down below or look it up on the Nevada Secretary of State Forms website.

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*170304*
*170304*
BARBARA K. CEGAVSKE
Secretary of State
202 North Carson Street
Carson City, Nevada 89701-4201
(775) 684-5708
Website: www.nvsos.gov
Certificate of Revival
(PURSUANT TO NRS 82.546)
Page 1
USE BLACK INK ONLY - DO NOT HIGHLIGHT
ABOVE SPACE IS FOR OFFICE USE ONLY
Certificate of Revival for a Nevada Nonprofit Corporation
(For Nonprofit Corporations Governed by
NRS Chapters 81 (except 81.010) and 82)
1. Name of corporation:
2. Registered Agent for service of process:
(check only one box)
Commercial Registered Agent:
Name
Noncommercial Registered Agent
Office or Position with Entity
(name and address below)
(name and address below)
Name of Noncommercial Registered Agent OR Name of Title of Office or Other Position with Entity
NEVADA
City
Street Address
Zip Code
NEVADA
City
Zip Code
Mailing Address (if different from street address)
3. Date when revival of charter is to commence or be effective, which may be before the date of
the certificate:
(month, day, year)
4. Indicate whether or not the revival is to be perpetual, and, if not perpetual, the time for which the
revival is to continue. The corporation's existence shall be:
PERPETUAL or
(Time for which the revival is to continue)
Nevada Secretary of State 82.546 Revival Page 1
This form must be accompanied by appropriate fees
Revised: 1-5-15
*170304*
*170304*
BARBARA K. CEGAVSKE
Secretary of State
202 North Carson Street
Carson City, Nevada 89701-4201
(775) 684-5708
Website: www.nvsos.gov
Certificate of Revival
(PURSUANT TO NRS 82.546)
Page 1
USE BLACK INK ONLY - DO NOT HIGHLIGHT
ABOVE SPACE IS FOR OFFICE USE ONLY
Certificate of Revival for a Nevada Nonprofit Corporation
(For Nonprofit Corporations Governed by
NRS Chapters 81 (except 81.010) and 82)
1. Name of corporation:
2. Registered Agent for service of process:
(check only one box)
Commercial Registered Agent:
Name
Noncommercial Registered Agent
Office or Position with Entity
(name and address below)
(name and address below)
Name of Noncommercial Registered Agent OR Name of Title of Office or Other Position with Entity
NEVADA
City
Street Address
Zip Code
NEVADA
City
Zip Code
Mailing Address (if different from street address)
3. Date when revival of charter is to commence or be effective, which may be before the date of
the certificate:
(month, day, year)
4. Indicate whether or not the revival is to be perpetual, and, if not perpetual, the time for which the
revival is to continue. The corporation's existence shall be:
PERPETUAL or
(Time for which the revival is to continue)
Nevada Secretary of State 82.546 Revival Page 1
This form must be accompanied by appropriate fees
Revised: 1-5-15
BARBARA K. CEGAVSKE
Secretary of State
202 North Carson Street
Carson City, Nevada 89701-4201
(775) 684-5708
Website: www.nvsos.gov
Certificate of Revival
(PURSUANT TO NRS 82.546)
Page 2
USE BLACK INK ONLY - DO NOT HIGHLIGHT
ABOVE SPACE IS FOR OFFICE USE ONLY
5. Names and addresses of President, Secretary, Treasurer and Directors:
(additional pages may
be attached as necessary)
Name of President or equivalent
Zip Code
Address
City
State
Name of Secretary or equivalent
Address
City
State
Zip Code
Name of Treasurer or equivalent
Address
City
State
Zip Code
Name of Director
Zip Code
Address
City
State
Name of Director
Zip Code
Address
City
State
This form must be accompanied by appropriate fees
Nevada Secretary of State 82.546 Revival Page 2
Revised: 1-5-15
BARBARA K. CEGAVSKE
Secretary of State
202 North Carson Street
Carson City, Nevada 89701-4201
(775) 684-5708
Website: www.nvsos.gov
Certificate of Revival
(PURSUANT TO NRS 82.546)
Page 3
USE BLACK INK ONLY - DO NOT HIGHLIGHT
ABOVE SPACE IS FOR OFFICE USE ONLY
6. The undersigned declare that the corporation desires to revive its corporate charter and is, or
has been, organized and carrying on the business authorized by its existing or original charter and
amendments thereto, and desires to continue through revival its existence pursuant to and subject
to the provisions of Chapters 81 and 82.
7. Signatures: This certificate must be executed by the President or Vice President AND
Secretary or Assistant Secretary.
The undersigned declare that the execution and filing of this certificate has been approved
unanimously by the last-appointed surviving directors of the corporation and the unanimous consent
has been secured:
I declare under the penalty of perjury that the revival has been authorized by a court of competent jurisdiction or by
the duly elected board of directors of the entity or if the entity has no board of directors, its equivalent of such board.
I declare, to the best of my knowledge under penalty of perjury, that the information contained herein is correct and
acknowledge that pursuant to NRS 239.330, it is a category C felony to knowingly offer any false or forged instrument
for filing in the Office of the Secretary of State.
X
Signature
Title
X
Signature
Title
A REGISTERED AGENT ACCEPTANCE MUST ACCOMPANY THIS CERTIFICATE
PRINT
IMPORTANT:
Failure to include any of the above information and submit with the proper fees may cause this filing to be rejected.
Nevada Secretary of State 82.546 Revival Page 3
This form must be accompanied by appropriate fees
Revised: 1-5-15
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