STATE OF MINNESOTA

SECRETARY OF STATE

Business Certificate/Copy Request

Contact Person: ________________________________ Phone Number: ________________________

Name: _______________________________________________________________________________
Address: _______________________________________________________________________________
City: _________________________________State: _________________Zip: _______________________

ORDER INFORMATION
Entity Name: (Required) File Number

Quantity Copies Certified Non-Certified

Original filing only $8.00 $3.00

Original Filing + All Amendments $11.00 $6.00
Renewal for the following year(s) _______ _______ or all $8.00* $3.00*

*No fee, if requested with the original and amendments

Specific document (describe): $8.00 $3.00

Quantity Certificates: $5.00 each

Good Standing Certificate
Name Change Certificate
Not In Good Standing Certificate
No Record Certificate (list name above exactly as is should appear on the certificate)
Special Certificate (describe):

Please debit my Secretary of State account number ____________________________________________

Please debit my ACH account number ______________________________________________________
Payment enclosed Make Check Payable to MN Secretary of State

FILE IN-PERSON OR MAIL TO:

Minnesota Secretary of State - Certification
Retirement Systems of Minnesota Building
60 Empire Drive, Suite 100
St Paul, MN 55103
(Staffed 8:00 - 4:00, Monday - Friday, excluding holidays)

r/bs/forms/CertificateCopyRequesRev08/2007

R:\BS\Forms\BS WORD Forms published on WEB\CurrrentForms\Other Forms\CertificateCopyRequest.doc 1 8/10/2007