For Office Use Only
REQUEST FOR CERTIFICATE OF
Corporate Certifications
EXISTENCE/AUTHORIZATION
312 Rosa L. Parks Ave.
(GOOD STANDING)
6 th Floor, William R. Snodgrass Tower
Nashville, TN 37243
The below named applicant hereby applies for a Certificate of Existence/Authorization for the below
listed corporation/limited liability company/limited partnership/limited liability partnership.
1. Exact name of the business:
State or country of incorporation/formation, if known:
Secretary of State control number, if known:
2. If more than one certification is requested, please indicate the number:
3. The name and mailing address of the party to receive this order:
Name ____________________________________________________
Address _________________________________________________
__________________________________________________________
City ______________________________________________________
State ____________________________ Zip Code _______________
NOTE: If the service of an "overnight"courier is to be utilized, a complete airbill (including the
account number to which the charges for service should be made) must accompany this request.
4. This request must be accompanied by the statutory fee of $20.00 per certification per business.
No credit will be extended. Make checks payable to: Tennessee Secretary of State. We regret
that no requests can be taken by telephone, e-mail, or fax.
SS-4238(Rev. 5/00)
RDA 1678