Form Cf-1 - Certificate Of Authority - West Virginia Secretary Of State
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1
2Betty Ireland
Penney Barker, Manager
Secretary of State
Corporations Division
State Capitol
Tel. (304) 558-8000
Fax (304) 558-5758
1900 Kanawha Blvd. E.
CERTIFICATE OF
Charleston, WV 25305
Hours: 8:30am-5:00pm
AUTHORITY
FILE ONE ORIGINAL
PLEASE READ INSTRUCTIONS
FEES PER SCHEDULE
CTRL # __ __ __ __
1.
HOME STATE INFORMATION:
a.
The name of the corporation as it is
registered in its home state is:
b.
State of ________________ Date of Incorp.__________________Duration
__________________
(# yrs. or perpetual)
Warning: Tax reporting requirements in West Va.
will not end until a withdrawal is filed.
c.
NAIC #
(If an insurance company)
2.
PRINCIPAL OFFICE INFORMATION:
a.
Address of the principal office of
No. & Street
the corporation:
City/State/Zip
b.
Mailing address, if different,
Street/PO Box
from above address:
City/State/Zip
3.
WEST VIRGINIA INFORMATION:
a.
Corporate name to be used in W. Va.:
Home state name as listed on line 1.a. above, if available.
(check one, follow instructions)
DBA name
b.
Address of registered office in
No. & Street
West Virginia, if any
City/State/Zip
c.
Mailing address in WV,
Street/PO Box
if different, from above
City/State/Zip
d.
Proposed purpose(s) for
transaction of business in WV
4.
AGENT OF PROCESS:
Properly designated person
Name
to whom notice of process
may be sent, if any:
Address
Form CF-1
Rev. 1/05
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