Application For Certificate Of Authority Of A Foreign Corporation State Form 38784
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APPLICATION FOR CERTIFICATE OF
CONNIE LAWSON
AUTHORITY OF A FOREIGN CORPORATION
SECRETARY OF STATE
CORPORATIONS DIVISION
State Form 38784 (R11 / 4-12) Corporate Form 112
302 W. Washington Street, Room E018
Approved by State Board of Accounts, 1995
Indianapolis, Indiana 46204
Telephone: (317) 232-6576
NOTES:
1. An Original Certificate of Existence duly authenticated by the proper authority from corporation's
Indiana Code 23-1-49-1 et seq.
23-1-49-3
domiciliary state within the last sixty (60) days must be submitted with this application.
2. A Registered Agent with an Indiana street address (not a PO BOX) must be listed in ARTICLE III.
Filing Fee: $90.00
1. Use 8 1/2” x 11” white paper for attachments.
INSTRUCTIONS:
2. Present original and one copy to address in the upper right corner of this form.
3. Please TYPE or PRINT.
4. Please visit our office on the web at
APPLICATION FOR CERTIFICATE OF AUTHORITY
OF
A FOREIGN CORPORATION
TO TRANSACT BUSINESS IN THE STATE OF INDIANA
The undersigned officer of the above corporation which was formed as:
A general business corporation
A professional corporation
desiring to effectuate the admittance of the Corporation to transact business in the State of Indiana, certifies the following facts:
ARTICLE I: Name
Name of Corporation ( Must be identical to name shown in Articles of Incorporation and Amendments thereto)
ARTICLE II: Address of Corporation
Address of the principal office of corporation (Number and street, city, state and ZIP code)
ARTICLE III: Registered Office and Registered Agent
Name of the Registered Agent of the corporation (cannot be the corporation itself)
Indiana address of the registered office of corporation (Number and street, city; P.O. Box not accepted))
ZIP code
INDIANA
ARTICLE IV: Date and State of Incorporation and Duration of Existence
State of incorporation
Date of incorporation in domiciliary state (month, day, year):
Expected period of duration listed in the Articles of Incorporation (perpetual, term of years or date certain e.g. December 31, 2050)
ARTICLE V: Corporate Officers
The names and business addresses of the officers of the Corporation:
Name
Title
Address (Number, street, city, state and ZIP code)
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