Form F0017 - Application For Registration Of Corporate Name (Foreign Corporations)

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F0017 - Page 1 of 2
OFFICE OF THE MISSISSIPPI SECRETARY OF STATE
P.O. BOX 136, JACKSON, MS 39205-0136
(601) 359-1333
*0017-1-2*
Application for Registration of Corporate Name
(For Foreign Corporations only)
1. Type of Corporation
Profit
Nonprofit
2. Name of Corporation
3. Corporation Postal Address
Address
-
City, State, ZIP5, ZIP4
4. Name and Street Address of the Applicant
Name
Physical
Address
P.O. Box
-
City, State, ZIP5, ZIP4
5. Name elected to use in Mississippi
6. State or country of incorporation
7. Date incorporated or formed
Rev. 02/96

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