Form Va-1 - Application For Voluntary Association
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4Natalie E. Tennant
Penney Barker, Manager
Secretary of State
Corporations Division
1900 Kanawha Blvd E
Tel: (304)558-8000
Bldg 1, Suite 157-K
Fax: (304)558-8381
Charleston, WV 25305
Website:
E-mail:
APPLICATION FOR
FILE ONE ORIGINAL
Office Hrs: Monday – Friday
8:30 a.m. – 5:00 p.m. ET
(Two if you want a filed
VOLUNTARY ASSOCIATION
stamped copy returned to you)
FEE: $50
Control # _____________
The name of the Voluntary Association shall be:
1.
______________________________________________
If the Association is formed under the laws of
_____________________ ___________________
another State, list the State and Date of Origin.
Home State
Date of Origin
The address of the principal office
2.
______________________________________________
Street:
of the association will be:
: ______________________________________________
City/State/Zip
located in the County of:
______________________________________________
County:
The mailing address of the above
______________________________________________
Street/Box:
location, if different, will be:
______________________________________________
City/State/Zip:
The name and address of the
3.
______________________________________________
Name:
person to whom notice of legal
process may be sent, if any, will be:
______________________________________________
Street:
City/State/Zip:
____________________________________________________
E-mail address where business correspondence may be received:
4.
_______________________________________
The association is organized as (check one)
5.
NON-PROFIT, NON-STOCK
FOR PROFIT
:
6. The Purpose of the voluntary association is:
______________________________________________________________________________________
______________________________________________________________________________________
7. The Name(s) and Address(es) of one or more of the Organizers of the Association: (Attach additional
sheet if necessary.)
Name
Street Address/City/State/Zip Code
___________________________________ __________________________________________________
___________________________________ __________________________________________________
Form VA-1
Issued by the Office of the Secretary of State
Revised 4/13
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