Application For Certificate Of Authority Of A Foreign Corporation - Indiana Secretary Of State - 1995

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SUE ANNE GILROY
APPLICATION FOR CERTIFICATE OF
SECRETARY OF STATE
AUTHORITY OF A FOREIGN CORPORATION
CORPORATIONS DIVISION
302 W. Washington St., Rm. E018
State Form 38784 (R6 / 8-95) Corporate Form 112
Indianapolis, IN 46204
Telephone: (317) 232-6576
Approved By State Board Of Accounts 1995
Indiana Code 23-1-49-1 et seq.
INSTRUCTIONS:
Use 8 1/2" x 11" white paper for inserts.
23-1-49-3
Present original and two (2) copies to address in upper right corner of this form.
FILING FEE: $90.00
Please TYPE or PRINT.
Upon completion of filing, the Secretary of State will issue a receipt.
This application cannot be accepted without an original certificate of existence duly authenticated by the proper authority
from corporation's domicilary state within the last sixty (60) days.
This application cannot be accepted unless a registered agent with an Indiana street address is listed in ARTICLE
II.
APPLICATION FOR CERTIFICATE OF AUTHORITY
OF
A FOREIGN CORPORATION
TO TRANSACT BUSINESS IN THE STATE OF INDIANA
The undersigned officer of the above______________________________________________________________ (State of Domicile)
corporation which was formed as:
A general business corporation
A professional corporation
desiring to effectuate the admittance of the Corporation to transact business in the State of Indiana, certifies the following facts:
ARTICLE I: Name and Principal Office
Name of Corporation ( Must be identical to name shown in Articles of Incorporation and Amendments thereto)
Address of the principal office of corporation (Number and street, city, state and ZIP code)
ARTICLE II: Registered Office and Registered Agent
Name of the registered agent of the corporation
Indiana address of the registered office of corporation (Number and street, city, state and Zip code)
ARTICLE III: Date of Incorporation and Duration of Existence
Date of incorporation in domicilary state:
Expected period of duration listed in the Articles of Incorporation
ARTICLE IV: Corporate Officers
The names and business addresses of the officers of the Corporation:
Name
Title
Address (Number, street, city, state and ZIP code)

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