Form Ct 06115-0470 - Organization And First Report Form - Office Of The Secretary Of The State
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1ORGANIZATION
AND FIRST REPORT
STOCK OR NON-STOCK CORPORATIONS
Office of the Secretary of the State
30 Trinity Street / P.O. Box 150470 / Hartford, CT 06115-0470 / Rev. 1211999
Please see reverse for instruction
Space For Ofice Use Only
1. Name of Corporation:
2. Date of Organization
Meeting:
I
I
Month
Dav
Year
3. Address of Principal Office
(street address required -
4. Mailing address
(if other than principal
office
P.O. Box is not acceptable):
address):
NAME
I
5. OFFICERS:
(Street address required - P.O. Box is not acceptable)
TITLE
RESIDENCE ADDRESS
BUSINESS ADDRESS
I
I
I
I
6. DIRECTORS:
NAME
(Street address required - P.O. Box is not acceptable)
RESIDENCE ADDRESS
BUSINESS ADDRESS
Note: If additional space is needed, please reference an 8 l/2 X 11 attachment
7. EXECUTION:
Dated this
day of
,20
.
Print or type name of signatory
Capacity of signatory
Signature
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