Form Co-Lp-Re - Application For Reinstatement Of A Revoked Or Adminstratively Dissolved(2009) Page 2
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1
2Annual Report for
Corporations, Limited Partnerships, Voluntary Associations, and/or Business Trusts
DUE DATE: July 1, 2008
Companies that do not file their annual reports by the due date are at risk of being assessed monetary penalties and/or being administratively
dissolved or revoked. Complete each section. (Please Print or Type Information)
1.
Name of Organization:
2.
Incorporation or Qualification date:
In which State:
3.
Tax ID: #
County Code:
Business Class Code:
To view a list of County Codes they are available at:
To view a list of Business Class Codes they are available at:
4.
Principal Office Address:
(if different, please make
appropriate changes)
5.
Principal Mailing Address:
(if different, please make
appropriate changes)
6.
Name and mailing address of the person
(if different, please make changes)
*If new agent furnish new agent’s signature: ____________________________________________________________
7.
Business email address to whom
correspondence may be sent, if any, is:
____________________________________________________________
8.
List names and addresses of the entity’s parent company, if any. Also, list each entity’s subsidiaries that are licensed to do business in
WV. Please check whether each name is a parent or a subsidiary by checking the appropriate box for each line (P for parent, S for
subsidiary) Attach list if more space is needed.
P
S
Organization Name
Mailing Address
__________________________
_____________________________________________________
P
S
Organization Name
Mailing Address
__________________________
_____________________________________________________
9.
Officer/Partner/Member Information: List the name and address of each officer/partner/member having authority to sign filings
(attach additional pages if necessary):
Name
Mailing Address
President
Vice-President
Secretary
Treasurer
Director
Director
10.
Report must be signed in the name of the company by a: (1) officer of a corporation, (2) general partner of a limited
partnership, (3) member or officer of a voluntary association or business trust.
Signature: __________________________________________________________ Date Signed: ____________________________
Title/Capacity of Person Signing: _______________________________________ Telephone #: ____________________________
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