Form Dfi/corp/21 - Foreign Business Corporation - Certificate Of Authority Application - 2015 Page 5

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FOREIGN BUSINESS CORPORATION
CERTIFICATE OF AUTHORITY APPLICATION
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▲ Enter your return address within the brackets above
Phone number during the day: (
)
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INSTRUCTIONS (Ref. sec. 180.1503 or 180.1504, Wis. Stats. for document content)
Please use BLACK ink. Submit one original along with the required filing fees and a current
CERTIFICATE OF STATUS to the address listed below. Make checks payable to the “Department of
Financial Institutions”. Filing fee is non-refundable. Sign the document manually or otherwise as
allowed under sec. 180.0103(16), Wis. Stats.
Mailing Address:
Physical Address for Express Mail:
Phone: 608-261-7577
State of WI-Dept. of Financial Institutions
Department of Financial Institutions
TTY: 711
Box 93348
Division of Corporate & Consumer Services
Milwaukee WI 53293-0348
201 W. Washington Ave – Suite 300
Madison WI 53703
NOTICE: This form may be used to accomplish a filing required or permitted by statute to be made
with the department. Information requested may be used for secondary purposes. This document can
be made available in alternate formats upon request to qualifying individuals with disabilities.
This application is appropriate for use by a foreign, for-profit stock corporation or cooperative
121
association. Foreign nonstock corporations, including nonprofit corporations, apply on Form
(
Foreign Nonstock Corporation – Certificate of Authority Application).
1. (A) For an ORIGINAL certificate of authority, complete items A 1 and A 2 and items 3 thru 16. If
the corporation has transacted business in Wisconsin without holding a certificate of authority, also
complete and submit the supplement on pages 5 & 6. Respond to all items. If the answer to any
item is “zero” or “none”, enter that remark.
1. (B) For an AMENDED certificate of authority, complete items B1, B2 and items 3 thru 7, 9 thru
11, and 15 and 16. Respond to all items. If the answer to any item is “zero” or “none”, enter that
remark. Supplement on pages 5 & 6 is not required. The certificate of status must be issued under
the new or continuing name of the corporation. A certified copy of the charter documents is not an
acceptable substitute.
DFI/CORP/21 (R03/15)
7

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