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Application For Certificate Of Authority Foreign Corporation - Connecticut Secretary Of The State - 2010

APPLICATION FOR CERTIFICATE OF AUTHORITY

FOREIGN CORPORATION

Office of the Secretary of the State

MAILING ADDRESS:

DELIVERY ADDRESS:

Commercial Recording Division

Connecticut Secretary of the State

P.O. Box 150470

30 Trinity Street

Hartford, CT 06115-0470

Hartford, CT 06106

860-509-6003

FEE: Stock $385.00

(INCLUDES $285.00 LICENSE FEE)

Non-Stock $40.00

Make Checks Payable To “Secretary of the State”

Space For Office Use Only

Please contact the Department of Revenue Services or your tax advisor as to any potential tax liability relating to your business.

1. NAME OF CORPORATION IN ITS STATE OR COUNTRY OF FORMATION:

2. THE CORPORATION'S NAME IS NOT AVAILABLE FOR USE IN CONNECTICUT. THE

CORPORATION SHALL, THEREFORE, TRANSACT BUSINESS IN CONNECTICUT UNDER THE

FOLLOWING NAME:

(Complete only if the name of the corporation is not available for use in Connecticut)

3. CHECK EITHER A OR B

_____A. The corporation is organized for profit.

_____B. The corporation is nonprofit.

4. STATE/COUNTRY OF INCORPORATION:

5. DATE OF INCORPORATION:

6. DURATION: (CHECK ONE)

____PERPETUAL

____OTHER

(SPECIFY)_________________

7. DATE CORPORATION BEGAN TRANSACTING BUSINESS/CONDUCTING AFFAIRS IN

CONNECTICUT:

_________/_________/_________

MONTH

DAY

YEAR

8. PRINCIPAL OFFICE ADDRESS OF THE

9. MAILING ADDRESS OF THE CORPORATION:

CORPORATION:

10. OFFICERS

NAME

TITLE

RESIDENCE ADDRESS

BUSINESS ADDRESS

Note: If additional space is needed, please reference an 8 1/2 X 11 attachment

R:\CommercialRecording\CRD WEB FORMS\docs\app for cert of auth - foreign corp.DOC

Application For Certificate Of Authority Foreign Corporation - Connecticut Secretary Of The State - 2010

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