Form 623 - Application For Renewal Of Registration Of Corporate Name Page 2
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2Filing Fee: $50.00
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Office of the Secretary of State
Corporations Division
148 W. River Street
Providence, Rhode Island 02904-2615
BUSINESS CORPORATION
____________
APPLICATION FOR
RENEWAL OF REGISTRATION OF CORPORATE NAME
Pursuant to the provisions of Section 7-1.2-404 of the General Laws of Rhode Island, 1956, as amended, the
undersigned foreign corporation hereby applies for a renewal of registration of its corporate name extending the
registration for a period of one year from the date of expiration of the filing of its original application, or last renewal
thereof, and submits the following statement:
1. The name of the corporation is
2. The corporation is incorporated under the laws of
3. The date of its incorporation is
4. The corporation is carrying on or doing business.
5. The business in which it is engaged is
6. This application is accompanied by (a) a certificate setting forth that the corporation is in good standing under the
laws of the state or territory wherein it is organized, executed by the secretary of state of the state or territory or by
any other official that may have custody of the records pertaining to corporations; and (b) the required registration fee.
Under penalty of perjury, I declare and affirm that I have
examined this Application for Renewal of Registration of
Corporate Name , including any accompanying attachments, and
that all statements contained herein are true and correct.
Date:
Signature of Authorized Officer of the Corporation
Type or Print Name of Authorized Officer
Submitted By:
Name
Address
Form No. 623
Revised: 12/05
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