Form F0002 - Application For Certificate Of Authority Form - State Of Mississippi

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F0002 - Page 1 of 3
OFFICE OF THE MISSISSIPPI SECRETARY OF STATE
P.O. BOX 136, JACKSON, MS 39205-0136
(601) 359-1633
Application for Certificate of Authority
The undersigned corporation, pursuant to Section 79-4-15.03 (if a profit corporation) or Section 79-11-367
(if a nonprofit corporation) of the Mississippi Code of 1972, hereby executes the following document and sets forth:
1. Type of Corporation
Business Email Address _________________________________
Profit
Nonprofit
2. Name of the Corporation
3. The future effective date is
(Complete if applicable)
4. Its state or country of incorporation is
5. Street Address of the corporation’s principal office
City, State, ZIP5, ZIP4
6. Date of incorporation
Period of duration
7. Name, Street and Mailing Address of the Registered Agent in Mississippi and Registered
Office are
Name
Physical
Address
P.O. Box
City, State, ZIP5, ZIP4
MS
Rev. 5/2009

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