Virginia State Corporation Commission Form Scc759/921 Application For A Certificate Of Authority To Transact Business In Virginia As A Foreign Corporation
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COMMONWEALTH OF VIRGINIA
Certified
STATE CORPORATION COMMISSION
Copy of the
Formation
APPLICATION FOR A CERTIFICATE OF AUTHORITY TO
SCC759/921
Document,
TRANSACT BUSINESS IN VIRGINIA AS A FOREIGN CORPORATION
(06/16)
as Amended
REVIEW THE INSTRUCTIONS BEFORE SUBMITTING THIS FORM.
Corporation’s name:
Designated name (if required):
State or other jurisdiction of incorporation:
Date of incorporation:
Period of duration:
The corporation was previously authorized or registered to transact business in Virginia as a
(Mark if applicable:)
foreign business entity
. (See Instructions.) Set forth additional information on an attachment.
The post office address, including the street and number, of the corporation's principal office is
.
(number/street)
(city or town)
(state)
(zip)
The corporation’s registered agent in VIRGINIA is
.
The registered agent is (mark appropriate box):
(1) an individual who is a resident of Virginia and
(2)
a Virginia or foreign stock or nonstock
corporation, limited liability company or
an officer of the corporation.
OR
registered limited liability partnership
a director of the corporation.
authorized to transact business in Virginia.
a member of the Virginia State Bar.
The corporation’s VIRGINIA registered office address, including the street and number, if any, which is identical to
the business office of the registered agent, is
________________________________________________________________________, VA _______________,
(number/street)
(city or town)
(zip)
.
which is physically located in the
county or
city of
OFFICERS:
NAME AND TITLE
BUSINESS ADDRESS
____________________________________________
__________________________________________________
__________________________________________________
____________________________________________
__________________________________________________
__________________________________________________
DIRECTORS:
NAME
BUSINESS ADDRESS
____________________________________________
__________________________________________________
__________________________________________________
____________________________________________
__________________________________________________
__________________________________________________
STOCK:
NUMBER OF SHARES AUTHORIZED TO BE ISSUED
CLASS
Signed in the name of the foreign corporation by:
________________________________________
__________________
___________________________
(signature)
(date)
(telephone number (optional))
________________________________________
________________________________________________
(printed name)
(title)
(see Instructions for examples of acceptable titles)
Personal Information, such as a social security number, should NOT be included in a business entity document submitted to the Office of the
Clerk for filing with the Commission. For more information, see Notice Regarding Personal Identifiable Information at
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