Form Co-Lp-Re - West Virginia Application For Reinstatement Of A Revoked Or Administratively Dissolved Corporation, Limited Partnership, Voluntary Association Or Business Trust - Wv Secretary Of State - 2009 Page 2
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1
2Annual Report for ________(year)
Corporations, Limited Partnerships, Voluntary Associations,
and/or Business Trusts
1.
Name of Organization: _________________________________________________________________________________
2.
Incorporation or Qualification Date: ____________________________ In which state: ___________________________
3.
Tax ID: #___________________________ County Code: ___________ Business Class Code: ______________________
4.
Principal Office Address:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
5.
Principal Mailing Address:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
6.
Name and Mailing Address
__________________________________________________________________
of person to whom notice
of process may be sent:
__________________________________________________________________
__________________________________________________________________
*If new agent furnish new agents signature: __________________________________________________________________
7.
Business email address to whom
correspondence may be sent: ____________________________________________________________________________
8.
List names and addresses of the entity’s parent company, if any. Also, list each entity’s subsidiaries that are licensed to
do business in WV. Please check whether each name is a parent or a subsidiary by checking the appropriate box for
each line (P for parent, S for subsidiary) Attach additional sheet if necessary.
P
S
Organization Name
Mailing Address
__________________________________ _______________________________________________________
P
S
Organization Name
Mailing Address
__________________________________ _______________________________________________________
9.
Officer/Partner/Member Information: List the name and address of each officer/partner/member having authority to sign
filings (attach additional pages if necessary):
Title
Name
Mailing Address
______________ ______________________________ ________________________________________________________
______________ ______________________________ ________________________________________________________
______________ ______________________________ ________________________________________________________
______________ ______________________________ ________________________________________________________
______________ ______________________________ ________________________________________________________
______________ ______________________________ ________________________________________________________
10. Report must be signed for the organization by a: (1) officer of a corporation, (2) general partner of a limited
partnership (3) member or officer of a voluntary association or business trust.
Signature: __________________________________________ Date Signed: ______________________________________
Title/Capacity of Person Signing: ______________________________ Telephone: _________________________________
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