Form Dfi/corp/21 - Foreign Business Corporation - Certificate Of Authority Application - 2015 Page 3

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12. (Continued)
Estimated 1
Year Activity
A.(1) Gross Business
$_____________
(2) Plus Total Assets
$_____________
(3) Total of lines (1) and (2)
$_____________
(4) Wisconsin business
$_____________
(5) Plus Wisconsin Assets
$_____________
(6) Total of lines (4) and (5)
$_____________
(7) Divide line (6) by line (3) and
enter percentage
___________%
(8) Value of Issued Shares of PAR VALUE
stock from item B (3)
$_____________
(9) Value of Issued Shares of NO PAR
VALUE stock from line C (7)
$_____________
(10) Total of lines (8) and (9)
$_____________
(11) Multiply line (10) by line (7) and
enter product here and item 13, below
$_____________
B. PAR VALUE STOCK (Use this section to compute valuation of Par Value stock only)
(1) Value of issued shares of Par Value stock,
computed at PAR, (number of issued shares in item
11 on page 2 multiplied by the par value per share) $_____________
(2) Paid-in capital, in excess of Par, applicable
to issued shares of Par Value stock
$_____________
(3) Total of lines (1) and (2). Also enter
$_____________
this sum on line A (8) above
C. NO PAR VALUE STOCK (Use this section to compute valuation of No Par Value stock only)
(1) Total assets (From item 12A(2) above.)
$_____________
(2) Deduct liabilities other than capital and
Surplus
$_____________
(3) Total of line (1) minus line (2)
$_____________
(4) Deduct amount of line A (8) above
$_____________
(5) Remainder of line (3) minus line (4)
$_____________
(6) Compute value of issued shares of NO PAR
VALUE stock at $10.00 per share (number of issued shares
from Item 11 on page 2 multiplied by $10.00)
$_____________
(7) Enter the GREATER of line (5) or line (6) here. Also
$_____________
enter this sum on line A (9) above.
13. The corporation’s capital represented in Wisconsin is $ ______________ (from item 12 (A) 11)
14. COMPUTATION OF FILING FEE
For the first $60,000 of capital represented in Wisconsin
$
100.00
Plus $3.00 per $1,000 of representation over $60,000
$ ____________
TOTAL FILING FEE (post to item 15)
$ ____________
DFI/CORP/21 (R03/15)
3

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