Form 500 - Copy/certificate Request - Ohio Secretary Of State
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1
2Form 500 Prescribed by:
J
H
ON
USTED
Mail this form to the following:
Ohio Secretary of State
P.O. Box 1329
Columbus, OH 43216
Central Ohio: (614) 466-3910
Toll Free: (877) SOS-FILE (767-3453)
Busserv@OhioSecretaryofState.gov
Copy/Certificate Request
(See Instructions for Fee Information)
Submitter's Information
Individual/Business Name
Attention (if applicable)
Mailing Address
City
State
ZIP Code
Phone Number
E-mail Address
Certificate Request Information
Entity Name
Charter/License/Registration Number
Pick up at Client Service Center
Return by Mail
Certificates
Number of Certificates Requested:
(Choose one by checking box below)
Good Standing Certificate
No Record Certificate
Full Force and Effect Certificate
Dissolution Certificate
Long Form Certificate
Cancellation Certificate
Name Change Certificate
Surrender Certificate
Agent Certificate
Date Filed
Conversion Certificate
Merger Certificate
Date Filed
Date Filed
Qualification Certificate (LLP only)
Consolidation Certificate
Date Filed
Date Filed
Form 500
Page 1 of 2
Last Revised: 2/6/12
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