Joe Manchin, III
Penney Barker, Team Leader
Secretary of State
Corporations Division
State Capitol, Suite 139-W
Tel. (304) 558-8000
Fax (304) 558-0900
1900 Kanawha Blvd. E.
Charleston, WV 25305
WEST VIRGINIA
APPLICATION FOR
PLEASE READ INSTRUCTIONS
FILE TWO ORIGINALS
FEES PER SCHEDULE
CERTIFICATE OF AUTHORITY
CTRL # __ __ __ __
1.
HOME STATE INFORMATION:
a.
The name of the corporation as it is
registered in its home state is:
________________________________________________________________
b.
State of ________________ Date of Incorp.__________________Duration
__________________
(# yrs. or perpetual)
Warning: Tax reporting requirements in West Va.
will not end until a withdrawal is filed.
2.
PRINCIPAL OFFICE INFORMATION:
a.
Physical location address of the
_____________________________________________________
No. & Street
principal office of the corporation:
_____________________________________________________
City/State/Zip
b.
Mailing address at this location,
_____________________________________________________
Street/PO Box
if different:
_____________________________________________________
City/State/Zip
3.
WEST VIRGINIA INFORMATION:
a.
Corporate name to be used in W. Va.:
Home state name as listed on line 1.a. above, if available.
(check one, follow instructions)
DBA name _______________________________________________
b.
Physical location address of principal
_____________________________________________________
No. & Street
office or activity in West Virginia:
_____________________________________________________
City/State/Zip
c.
Mailing address at this location,
_____________________________________________________
Street/PO Box
if different
_____________________________________________________
City/State/Zip
d.
County in W. Va. where Certificate
of Authority will be recorded:
________________________________________________________________
e.
Proposed purpose(s) for transaction
________________________________________________________________
of business in West Virginia:
________________________________________________________________
4.
AGENT OF PROCESS:
Properly designated person
__________________________________________________________
Name
to whom notice of process
may be sent:
__________________________________________________________
Address
5.
CORPORATE STATUS INFORMATION:
a.
Corporation is organized as
:
For profit, stock
(check one)
(complete all remaining items)
Non-profit, non-stock
(complete all remaining items except c & d)
Form CF-1