Application Form For Certificate Of Authority Of A Foreign Nonprofit Corporation - Corporation Division - State Of Missouri

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State of Missouri
Rebecca McDowell Cook, Secretary of State
P.O. Box 778, Jefferson City, MO 65102
Corporation Division
Application for Certificate of Authority
of a Foreign Nonprofit Corporation
(Submit in duplicate with filing fee of $25.00)
The corporation’s name is
(1)
and it is organized and existing under the laws of
The name it will use in Missouri is
(2)
, and the period of its duration is
The date of its incorporation was
(3)
Month/Day/Year
The address of its principal place of business is
(4)
City/State/Zip
Address
The name and address of its registered agent and office in the State of Missouri is
(5)
City/State/Zip
Address
Name
The names of its officers and directors and their business or home addresses are as follows (attach
(6)
additional sheets as necessary):
City/State/Zip
Name
Address
President
Vice President
Secretary
Treasurer
Director
Director
The specific purpose(s) of its business in Missouri:
(7)
Does the corporation have members? Yes
(8)
or mutual benefit
If incorporated in Missouri would the corporation be a public benefit
(9)
corporation?
The effective date of this document is the date it is filed by the Secretary of State of Missouri, unless you
(10)
indicate a future date, as follows:
(Date may not be more than 90 days after the tiling date in this office)
In affirmation of the facts stated above,
(Date of Signature)
(Title)
(Authorized signature of officer or chairman of the board)
Note: You must have a current certificate of good standing or certificate of existence with this application. This
may be obtained from the secretary of state or other authority that issues corporate charters.
Corp. #55A (6-95)

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