Form Dfi/corp21 - Foreign Business Corporation - Certificate Of Authority Application - 1999 Page 3
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12. (Continued)
Estimated 1
Year Activity
A.(1) Gross Business
$_____________
(2) Plus Total Assets
$_____________
(3) Total of lines (1) and (2)
$_____________
(4) Wisconsin business
$_____________
(5) Plus Wisconsin Assets
$_____________
(6) Total of lines (4) and (5)
$_____________
(7) Divide line (6) by line (3) and
enter percentage
___________%
(8) Value of Issued Shares of PAR VALUE
stock from item B (3)
$_____________
(9) Value of Issued Shares of NO PAR
VALUE stock from line C (7)
$_____________
(10) Total of lines (8) and (9)
$_____________
(11) Multiply line (10) by line (7) and
enter product here and item 13, below
$___________
B. PAR VALUE STOCK (Use this section to compute valuation of Par Value stock only)
(1)
Value of issued shares of Par Value stock,
computed at PAR
$_____________
(2) Paid-in capital, in excess of Par, applicable
to issued shares of Par Value stock
$_____________
(3) Total of lines (1) and (2). Also enter
$_____________
this sum on line A (8) above
C. NO PAR VALUE STOCK (Use this section to compute valuation of No Par Value stock only)
(1) Total assets
$_____________
(2) Deduct liabilities other than capital and
Surplus
$_____________
(3) Total of line (1) minus line (2)
$_____________
(4) Deduct amount of line A (8) above
$_____________
(5) Remainder of line (3) minus line (4)
$_____________
(6) Compute value of issued shares of NO PAR
VALUE stock at $10.00 per share
$_____________
(7) Enter the GREATER of line (5) or line (6) here. Also
$_____________
Enter this sum on line A (9) above.
13. The corporation’s capital represented in Wisconsin is $ ______________ (from item 12 (A) 11)
14. COMPUTATION OF FILING FEE
For the first $60,000 of capital represented in Wisconsin
$
100.00
Plus $2.00 per $1,000 of representation over $60,000
$ ____________
TOTAL FILING FEE (post to item 15)
$ ____________
21
DFI/CORP
(R5/99)
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