Form 612 - Application For Transfer Of Authority - Rhode Island And Providence Plantations Secretary Of State Page 2
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ID Number:
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Office of the Secretary of State
Division of Business Services
148 W. River Street
Providence, Rhode Island 02904-2615
APPLICATION FOR TRANSFER OF AUTHORITY
(Insert full name of the entity following the transfer)
SECTION I: TO BE COMPLETED BY ENTITY TRANSFERRING AUTHORITY
Pursuant to the applicable provisions of the Rhode Island General Laws, 1956, as amended, the undersigned duly
qualified foreign (check one box only):
Non-Profit Corporation or
Business Corporation or
Limited Liability Company or
Limited Partnership or
Limited Liability Partnership
submits the following Application for the purpose of transferring its authority to a (check one box only):
Limited Partnership or
Limited Liability Company or
Business Corporation or
Limited Liability Partnership or
Non-Profit Corporation
a. The name of the entity filing this application for transfer is:
b. The date on which the entity filing this application qualified to conduct business in the State of Rhode Island:
__________________________________________________________________________________________
c. The jurisdiction upon transfer of authority:
d. The name of the entity following the transfer of authority is:
e. The application for transfer is filed as an accompanying certificate to the
certificate of registration for a limited
partnership or
application for registration for a limited liability company or
application for certificate of
authority for a business corporation or
application for certificate of authority for a non-profit corporation or
notice of registration for a registered limited liability partnership (check one box only).
f.
The application for transfer is accompanied by a certificate of good standing or legal existence issued by the
proper officer of the state or country under the laws of which it is incorporated.
Form 612
05/12
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