Secretary of State
FILE NO. ___________________
State Capitol
500 E. Capitol Ave.
RECEIPT NO. _______________
Pierre SD 57501
Phone 605-773-4845
Clear Form
Fax 605-773-4550
Application for Certificate of Authority
Pursuant to the provisions of SDCL 47-8-7, the undersigned corporation hereby applies for a Certificate of Authority to transact
business in the State of South Dakota and for that purpose submits the following statement:
(1) The name of the corporation is
(exact corporate name)
(2) If the name of the corporation does not contain the word "corporation", "company", "incorporated" or "limited" or does not contain
an abbreviation of one of such words, then the name of the corporation with the word or abbreviation which it elects to add
thereto for use in this state is
(3) State where incorporated
Federal Taxpayer ID#
(4) The date of its incorporation is
and the period of its duration, which may be
perpetual, is
.
(5) The address of its principal office in the state or country under the laws of which it is incorporated is
Zip Code
mailing address if different from above is:
Zip Code
(6) The street address, or a statement that there is no street address, of its proposed registered office in the State of South Dakota is
Zip Code
and the name of its proposed registered agent in the State of South Dakota at that address is
(7) The purposes which it proposes to pursue in the transaction of business in the State of South Dakota are: (state specific purpose)
(8) The names and respective addresses of its directors and officers are:
Name
Officer Title
Street Address
City
State
Zip
(9) The aggregate number of shares which it has authority to issue, itemized by classes, par value of shares, shares without par value,
and series, if any, within a class is:
Number
Par value per share or statement that
of shares
Class
Series
shares are without par value