Secretary Of The State Of Connecticut Application For Certificate Of Authority Foreign Corporation Page 6

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13. EXECUTION: The document must be executed by an authorized official of the corporation. That person must print or
type their name, state the capacity under which they sign and provide a signature. The execution constitutes a legal
statement under the penalties of false statement that the information provided in the document is true.
OFFICE OF THE SECRETARY OF THE STATE
MAILING ADDRESS:
COMMERCIAL RECORDING DIVISION
CONNECTICUT SECRETARY OF THE STATE
P.O. BOX 150470
HARTFORD, CT 06115-0470
DELIVERY ADDRESS:
COMMERCIAL RECORDING DIVISION
CONNECTICUT SECRETARY OF THE STATE
30 TRINITY STREET
HARTFORD, CT 06106
PHONE: 860-509-6003
WEBSITE:
FORM CFAS-1-1.0
DO NOT SCAN THIS PAGE
INSTRUCTIONS
Rev. 8/2012

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