Fnc Application For Certificate Of Authority - Wyoming Secretary Of State, Consent To Appointment By Registered Agent - Wyoming Secretary Of State Page 2

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8. Names and usual business addresses of its current officers and directors:
Office
Name
Address
President
Vice President
Secretary
Treasurer
Director
Director
Director
9. Does this corporation have members?
Yes
No
10. If this corporation had been incorporated under the laws of this state, would it be
:
(Check appropriate choice.)
a. Public benefit corporation
b. Mutual benefit corporation
c. Religious corporation
12. The corporation accepts the constitution of the state of Wyoming in compliance with the requirement of Article
10, Section 5 of the Wyoming Constitution.
13. For name availability purposes list the type of business the nonprofit corporation will be conducting:
Date:
Signature: ___________________________________________
(mm/dd/yyyy)
(May be executed by Chairman of Board, President or another of its officers.)
Print Name:
Title:
Contact Person:
Daytime Phone Number:
Checklist
Filing Fee: $25.00 Make check or money order payable to Wyoming Secretary of State.
The completed application must be accompanied by an original certificate of existence/good standing, or
a document of similar import, dated not more than sixty (60) days prior to filing in Wyoming.
The Application must be accompanied by a written consent to appointment executed by the registered agent.
For consistency the Secretary of State’s Office will only keep one version of the agent’s name on file.
Please submit one originally signed document and one exact photocopy of the filing.
Please review form prior to submitting to the Secretary of State to ensure all areas have been
completed to avoid a delay in the processing of your documents.
Evidence of filing will be a file stamped copy and receipt. An official certificate may be obtained for a
$3.00 fee.
FNP-CertificateAuthority – Revised 12/2008

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