Form Cf-1 - Certificate Of Authority - 2013
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1
2
3Natalie E. Tennant
Penney Barker, Manager
Secretary of State
Corporations Division
1900 Kanawha Blvd E
Tel: (304)558-8000
Bldg 1, Suite 157-K
Fax: (304)558-8381
Charleston, WV 25305
Website:
E-mail:
FILE ONE ORIGINAL
CERTIFICATE OF
Office Hours: Monday – Friday
8:30 a.m. – 5:00 p.m. ET
(Two if you want a filed
AUTHORITY
stamped copy returned to you)
FEE: $100.00 for profit
$50.00 non-profit
Control #________________
1. Home State Information:
a. The name of the corporation as it is
registered in its home state is:
_______________________________________________
b. State of ______________ Date of Incorp: _____________ Duration
(no. yrs or perpetual) __________
c. NAIC#
__________________________________
(if an insurance company)
CHECK HERE to indicate you have obtained and submitted with this application a CERTIFICATE OF
EXISTENCE (GOOD STANDING), dated during the current tax year, from your home state of original
incorporation as required to process your application. The certificate may be obtained by contacting the
Secretary of State’s Office in the home state of original incorporation.
2. Principal Office Information:
a. Address of the principal office of
____________________________________
No. & Street:
the corporation:
__________________________________
City/State/Zip: __
b. Mailing address, if different
____________________________________
Street/PO Box:
from above address:
____________________________________
City/State/Zip:
West Virginia Information:
3.
a. Corporate name to be used in W. Va.:
Home state name as listed on line 1.a above, if available
[The name must contain one of the required
(If name is not available, check DBA Name box below and
terms such “Corporation,” “Corp.” or “Inc.”
follow special instructions in Section 3a. attached.)
See instructions for complete list of acceptable
terms and requirements for use of trade name.]
DBA name ___________________________________
(See special instructions in Section 3a. regarding the Letter of
Resolution attached to this application.)
b. Address of registered office in West
_____________________________________
No. & Street:
Virginia, if any:
_____________________________________
City/State/Zip:
c. Mailing address in WV, if different
_____________________________________
Street/PO Box:
from above:
_____________________________________
City/State/Zip:
Form CF-1
Issued by the Office of the Secretary of State
Revised 8/13
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