Form Cf-2 - Application For Exemption From Certificate Of Authority
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1.
.
.
Natalie 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:
APPLICATION FOR EXEMPTION
FILE ONE ORIGINAL
Office Hours: Monday – Friday
FROM CERTIFICATE OF
8:30 a.m. – 5:00 p.m. ET
(Two if you want a filed
stamped copy returned to you)
AUTHORITY
FEE: $25.00
Control #______________
Corporate Information
1.
The name of the corporation applying to do business in WV: _______________________________________
2.
The company was incorporated under the laws of the State of:
__________________________________
Date of Incorporation: __________________________________
3.
The address of the principal office of the corporation is:
___________________________________________
__________________________________________
No. & Street
City/State/Zip Code
4.
The type of business to be conducted in WV is: _________________________________________________
5.
Are on site contractual services provided to another business located in WV? YES / NO If YES, please describe:
____________________________________________________________________________________
6.
Will you maintain an office in WV? If yes, where?
No
Yes, at:______________
7.
Will you apply for a contractor’s license for construction work?
No
Yes
8.
Is the business in the state limited to sales? If yes, answer a-d
No
Yes
a. Does any salesperson reside in the state?
No
Yes
b. Will any salesperson need WV Workers’ Comp. coverage?
No
Yes
c. Does your salesperson have authority to finalize a contract?
No
Yes
d. How are goods shipped to your customers?
Common Carrier
Co. Vehicles
9. Do you expect work to be limited to only one occasion of no
No, we plan on multiple jobs or on-
more than one month?
going business
_______
______
Yes, Beginning
ending:
10. Will you have employees, other than sales people working
No
Yes
within the state? If yes answer a-c.
a. Will WV taxes be withheld?
No
Yes
b. Will they have WV Unemployment Coverage?
No
Yes
c. Will they have WV Workers’ Comp. Coverage?
No
Yes
Basis for Claiming Exemption:
11. List section number(s) of the WV Code
§31D-15-1501
(for profit entities) or WV Code
§31E-14-1401
(non-
profit entities) which makes your business exempt from being required to maintain a certificate of authority.
Enter the appropriate Code Number from the attached list of codes in the blank space provided below.
Code Number:
_______ (for profit entities) | _______ (non-profit entities)
Other [See section (c) of the Code in the attached list for profit and non-profit entities]: ________________
_______________________________________________________________________________________
_______________________________________________________________________________________
12. Print name of signer: __________________________________ Title/Capacity: ____________________
Signature: ___________________________________________ Date: ___________________________
Form CF-2
Issued by the Office of the Secretary of State
Revised 4/13
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