Application For Authority To Conduct Affairs For A Foreign Corporation

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For Office Use Only

File Number ________________________

State of Utah

generated.

DEPARTMENT OF COMMERCE

Non-Refundable Processing Fee:

[ ] Profit

$52.00

Division of Corporations & Commercial Code

[ ] Nonprofit

$22.00

Application for Authority to Conduct Affairs for a Foreign

Corporation

Print Form

Clear Form

A certification of Good Standing/Existence from the State of Incorporation dated no earlier than ninety (90) days prior to filing with this office

is attached to this application.

1. Exact Corporate Name:

2. A corporation of the state of:

3. Date Incorporated:

4. The corporation’s period of duration is:

(usually perpetual)

_________________________________________________

5. The address of the corporation's principal

Street Address Line 1

office is:

_________________________________________________

Street Address Line 2

City

State

Zip

6. The Registered Agent in Utah is:

_________________________________________________

7. The address of the registered office in Utah

Street Address Line 1

is:

_________________________________________________

Utah Street Address Required, PO Boxes can be listed on the

line below the Street Address

Street Address Line 2

City

State

Zip

8. I, ____________________________, agree to serve as a registered agent for the above-mentioned foreign corporation.

The Registered Agent must sign here after the form is printed

_____________________________________________________

Signature of Registered Agent (Required).

9. If the name is not available in Utah the corporation shall use as it’s name: {Please refer to (U.C.A. 16-10a-1506)}

10. The corporation commenced or intends to commence business in Utah on:

11. The names and addresses of the corporation's officers and directors are:

Position:

Name

Address

City

State

Zip

President

Vice-President

Secretary

Treasurer

Director

Other

12. The business purposes to be pursued in Utah are:

Under penalties of perjury, I declare that this application for Certificate of Authority has been examined by me and is, to the best of my knowledge

and belief, true, correct and complete.

A corporate officer/director must sign here after the form is printed

______________________________________

____________________________________

Authorized Signer Signature

Title

Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, the business

entity physical address may be provided rather than the residential or private address of any individual affiliated with the entity.

Mailing/Faxing Information:

Division's Website:

Mail In: PO Box 146705

Salt Lake City, UT 84114-6705

Walk In: 160 East 300 South, Main Floor

Information Center: (801) 530-4849

Toll Free: (877) 526-3994 (within Utah)

Fax: (801) 530-6438