Certificate Of Authority Foreign Corporation Application Form - North Dakota Secretary Of State

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COMPLETE, PRINT, SIGN, AND FAX OR MAIL (If paying with credit card, complete Credit Card Payment Authorization on page 3)

FOR OFFICE USE ONLY

CERTIFICATE OF AUTHORITY FOREIGN

System ID Number

CORPORATION APPLICATION

SECRETARY OF STATE

WO Number

SFN 13100 (7-2012)

Filed

The application MUST be accompanied by ALL of the following:

The following MAY be required:

1A.

Certificate of Professional License from the North Dakota

Filing fee of $145 if a Foreign Business or Professional Corporation



licensing board for the profession

Filing fee of $50 if a Foreign Nonprofit Corporation



Signed Consent to Use Business Name and fee of $10

Current CERTIFICATE OF GOOD STANDING OR CERTIFICATE OF



Trade Name Registration and fee of $25

EXISTENCE verifying corporate existence certified by the incorporating



officer of the state or country of incorporation.

SEE INSTRUCTIONS FOR FEES, FILING AND MAILING INFORMATION

TYPE OR PRINT LEGIBLY

For reference, see North Dakota Century Code Section 10-19.1-135 or 10-33-125.

Type of Corporation Applying for Certificate of Authority (check one)

Foreign Business

Foreign Professional

Foreign Nonprofit

3A.

Name of Corporation EXACTLY as it appears on Certificate of Good Standing or Certificate of Existence from

B. Federal ID Number

State or Country of Origin

If applicable, provide the trade name and complete the Trade Name Registration form if:

The corporate name in number 3A is not in the form as required of corporations in North Dakota.

The Secretary of State has notified the corporation that its corporate name is the same or deceptively similar to a name already registered, and the

corporation is unable to obtain consent to use of name from the previous filer or a certified copy of a final decree of a court of competent jurisdiction

establishing prior right of this corporation to use of the name in North Dakota.

The corporation does not wish to use or protect its corporate name in North Dakota and chooses to use a name other than its corporate name.

4. Complete Mailing Address of Principal Executive Office (Street/RR, PO Box, City, State, ZIP+4)

Address cannot only be a post office box.

C. Duration of Corporation

5A. STATE or Country Where Incorporated

B. EXACT Date Incorporated (M/D/Y)

Perpetual

Other - Specify (M/D/Y):

D. Telephone Number

E. Toll-free Telephone Number

6A. Name of Commercial Registered Agent in North Dakota

6B. Name of Noncommercial Registered Agent in North Dakota

6C. Address of Noncommercial Registered Agent in North Dakota (Street/RR, PO Box, City, State, ZIP+4)

6C. Address of Noncommercial Registered Agent in North Dakota (Street/RR, PO Box, City, State, ZIP+4) Address cannot only be a post office box.

7. Nature of Business or Activities the Corporation Intends to Conduct in North Dakota

OFFICERS AND DIRECTORS OF THE CORPORATION

Check box

if Officer

COMPLETE MAILING ADDRESS

also serves

OFFICER

NAME

Street/RR

PO Box

City

State

ZIP+4

as Director

PRESIDENT

VICE PRESIDENT

SECRETARY

TREASURER

DIRECTOR

"The undersigned, a person authorized by the corporation to sign this application, knows the contents, and believes the statements to be true. I further

authorize the Secretary of State to correct numbers 3A, 5A, 5B, 6A, 6B and 6C if not correctly reflected. I understand that if I make a false statement in this

document, I may be subject to criminal penalties."

Signature

Date

Daytime Telephone Number and Extension, if

10. Name of Person to Contact about this Document

Email Address

any