Form Cf-1 - Application For Certificate Of Authority Page 2
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25. (cont)
Directors and Officers:
(Add extra page if necessary; please list all officers.)
b.
Office
Name
Address
c.
Shares of Stock:
No. of Shares
Class
Series
Par Value/Share
or No Par Value
(1)
The aggregate number of shares which the
corporation has authority to issue, itemized
by classes and series within a class, if any,
and par value of shares is:
(2) The aggregate number of shares which the
corporation has issued or are outstanding,
itemized by classes and series within a
class, if any, and par value of shares is:
d.
Stated Capital and Property
(see instructions; estimates must be reasonable)
(1) The amount of stated capital is:
$______________________
(2) A reasonable estimate of the value of all property to be owned
by the corporation for the following year, wherever located, is:
$______________________
(3) A reasonable estimate of the value of all property to be owned and
used within West Virginia for the following year is:
$______________________
(4) Proportion of all property in West Virginia is:
$__. __ __ __ __
(divide d(3) by d(2), give answer to 4 decimals)
(5) Apportioned value of issued capital stock is:
$______________________
(multiply d(4) X d(1))
(6) The number of acres of land it holds or expects to hold in West Virginia is:
$______________________
e.
Estimated Business to be Transacted
(see instructions; estimates must be reasonable; minimal values not acceptable)
The total estimated gross amount of business to be transacted for the following year is:
(1)
At or from all locations:
$______________________
(2)
At or from places of business in West Virginia:
$______________________
Dated:______________________, 19____
By:
_________________________________________, Its President or Vice President
STATE OF ___________________
________________________________________, Its Secretary or Asst. Secretary
COUNTY OF _________________
The foregoing instrument was acknowledged before me this day of ______________ by___________________________________ and
(name of president or v.p. signing document)
___________________________ of________________________________, a _______________ corporation, on behalf of the corporation.
(name of secretary or asst sec. signing)
(name of corporation)
(state of incorporation)
My commission expires___________________ ___________________________________
(Signature of Notary Public)
(Place Notary Seal in this space)
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