APPLICATION FOR CERTIFICATE OF AUTHORITY
TO TRANSACT BUSINESS
John A. Gale, Secretary of State
Room 1301 State Capitol, P.O. Box 94608
Lincoln, NE 68509
Attach a certificate of existence, or document of similar import, duly authenticated by the secretary of
state or other official having custody of the corporate records in the state or country under whose law the
corporation is incorporated. Such certificate shall not be more than sixty (60) days old. A certified copy
of the articles of incorporation should not be submitted and is not acceptable in lieu of such certificate.
Name of Corporation____________________________________________________________
Fictitious Name of Corporation*___________________________________________________
(to be used only if actual corporate name is unavailable for use or does not comply with Nebraska law)
*Must provide a resolution from the Board of Directors signed by the Secretary adopting this fictitious
name. Note: Fictitious name must contain one of the words incorporated, corporation, limited or an
abbreviation thereof.
Incorporated under the laws
of_____________________________________________________
Date of Incorporation____________________ Period of Duration_______________________
Address of Principal Office_______________________________________________________
Street Address
City
State
Zip
Registered Agent_______________________________________________________________
Registered Office___________________________________________________NE_________
Street Address and Post Office Box (if any)
City
Zip
Effective date if other than the date filed __________________
_________________________________
__________________________________
Signature
Printed Name/Title
The Model Business Corporation Act requires that every filing be signed by the chairperson of the board of directors, the
president, or one of the officers of the corporation. If the corporation has not yet been formed or directors have not yet been
selected, the filing shall be signed by an incorporator. If the corporation is in the hands of a receiver, trustee, or other court
appointed fiduciary, the filing shall be signed by that fiduciary.
NOTE: To complete this filing you must provide a list of officers and directors names and street
.
addresses
FILING FEE: $145.00 (if you have more than one page listing officers and directors please add
$5.00 a page for each additional page)
Revised January 1, 2017
Neb. Rev. Stat.
21-2,205
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