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Form Fbt-01 - Application Form For Certificate Of Registration Of Foreign Business Trust - Arkansas Secretary Of State

Arkansas Secretary of State

ark

artin

State Capitol • Little Rock, Arkansas 72201-1094

501-682-3409 •

Business & Commercial Services, 250 Victory Building, 1401 W. Capitol, Little Rock

Application for Certificate of Registration

of Foreign Business Trust

(Please type or print)

Pursuant to the provisions of Act 1366 of 1999 the undersigned, as the duly authorized and acting member or managing

agent of the Foreign Business Trust for which this statement is submitted, under oath, does hereby state:

1a. The name of the Foreign Business Trust is:

1b. Assumed business name, it any:

2. The state, territory or foreign country under whose laws the Foreign Business Trust was organized is:

3. Physical location of principal office:

4. The name(s) and address(es) of the trustee(s) of the Foreign Business Trust is (are):

(Name or Names)

(Street Address)

(City)

(State)

(ZIP Code)

(Name or Names)

(Street Address)

(City)

(State)

(ZIP Code)

5a. The name and physical address of the registered agent for service:

(Name)

(Street Address)

(City)

(State)

(ZIP Code)

5b. Acknowledgment and acceptance of appointment MUST be signed. I hereby acknowledge and accept the appoinment

of registered agent for and on behalf of the above named Foreign Business Trust.

I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class C misde-

meanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.

(Authorized Signature)

Authorizing Officer (Type or Print)

6. A filing fee of $300.00 is submitted herewith in accordance with Act 1366 of 1999.

IN WITNESS THEREOF, the undersigned has executed this application on this day of _______________________.

(Name of Foreign Business Trust)

(Trustee)

State of

County of

Subscribed and sworn to before me, a Notary Public, this

, day of

Signature of Notary Public (Please apply seal at right)

Fee: $300.00 payable to Arkansas Secretary of State

FBT-01 Rev. 4/06

Form Fbt-01 - Application Form For Certificate Of Registration Of Foreign Business Trust - Arkansas Secretary Of State

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