Certificate Of Reinstatement Stock Or Non-Stock Corporation - Office Of The Secretary Of The State
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1CERTIFICATE
OF REINSTATEMENT
STOCK OR NON-STOCK
CORPORATION
Office of the Secretary of the State
30 Trinity Street / P.O. Box 150470 / Hartford, CT 06115-047OiRev. 12/1999
Note:
This certificate must be accompanied by a current annual report and up to date clearance letters from
the Department of Revenue Services and the Department of Labor.
Please see reverse for instruction
Space For Offwe Use Ooly
.
NAME OF CORPORATION:
.
PLACE A CHECK MARK NEXT TO A. m B.:
A. The corporation
is a Connecticut
Stock Corporation.
B. The corporation
is a Connecticut Non-stock Corporation.
. APPOINTMENT
OF REGISTERED AGENT: tPlease select one A. or B.)
Individual’s
Name:
I
Business address:
Residence address:
Business Entity:
Address:
Acceptance of appointment
Signature of agent
4. EXECUTION:
Dated this
day of
920
*
Print or type name of signatory
Capacity of signatory
signature
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