Form 6a - Corporate Resolution - Securities And Business Regulation - 2011
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1SECURITIES AND BUSINESS REGULATION
237 Coliseum Drive.
Macon, Georgia 31217-3858
(478) 207-2440
BRIAN P. KEMP
Commissioner of Securities
CORPORATE RESOLUTION
OF
(Print or Type Name of Corporation)
RESOLVED, that it is desirable and in the best interest of this Corporation that its securities be qualified or
registered for sale in various states; that the President or any Vice-President and the Secretary or an
Assistant Secretary hereby are authorized to determine the states in which appropriate action shall be taken
to qualify or register for sale all or such part of the securities of this Corporation as said officers may deem
advisable; that said officers are hereby authorized to perform on behalf of this Corporation any and all such
acts as they may deem necessary or advisable in order to comply with the applicable laws of any such
states, and in connection therewith to execute and file all requisite papers and documents, including, but not
limited to, applications, reports, surety bonds, irrevocable consents and appointments of attorneys for
service of process; and the execution by such officers of any such paper or document or the doing by them
of any act in connection with the foregoing matters shall conclusively establish their authority therefor from
this Corporation and the approval and ratification by this Corporation of the papers and documents so
executed and the action so taken.
This ______________ day of ___________________ , 20 ____ .
Applicant: _
_
_
_
_
_
_
By: ______________________________________________
(Authorized Corporate Officer Signature)
______________________________________________
(Print or Type Name & Title)
State of ___________________
County of __________________
The undersigned, ____________________________________
being first duly sworn, deposes
and says: That he/she has executed the foregoing application for and on behalf of the applicant named
therein; that he/she is _________________________________
of such applicant and is fully
authorized to execute and file such application; that he/she is familiar with such application; and that to the
best of his/her knowledge, information and belief, the statements made in such application are true, and the
documents submitted therewith are true copies of the originals thereof.
____________________________________________
(Authorized Signature)
Subscribed and sworn to before me this
____ day of ______________ , 20 __ .
_______________________________
(Notary Public)
State of _______________________ _________________________
My Commission Expires: _________ ___________
(Notarial Seal)
Form 6A (Form U2A may be used) Rev. 2/2011
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