Form Cf-2 - Application For Exemption From Certificate Of Authority - 2017
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1
2West Virginia Secretary of State
Penney Barker, Manager
1900 Kanawha Blvd. East
Business & Licensing Division
Bldg. 1, Suite 157-K
Tel: (304)558-8000
Charleston, WV 25305
Fax: (304)558-8381
Website:
E-mail:
Office Hours: Monday - Friday
APPLICATION FOR EXEMPTION FROM
FILE ONE ORIGINAL
8:30 a.m. - 5:00 p.m. EST
(Two if you want a filed
CERTIFICATE OF AUTHORITY
stamped copy returned to you.)
FILING FEE:
Control #
$25.00
Corporate Information
1. The name of the corporation applying to do business in WV:
_______________________________________
_____________________________________________________________________________________
_________________________________
2. The company was incorporated under the laws of the State of:
________________________________
Date of Incorporation:
The address of the principal office
3.
Street:
of the organization is:
City:
State:
Zip Code:
4. The name and address of the Agent
Name:
(person or company) to whom
notice of process may be sent,
Street:
if any, will be:
Zip Code:
City:
State:
Business/Employees in WV:
_______________________________________________
5.
The type of business to be conducted in WV is:
6. Are on site contractual services provided to another business located in WV? YES / NO If yes, please describe:
_____________________________________________________________________________________
.
7.
Will you maintain an office in WV? If "Yes," where?
No
Yes, at:
__________________
8.
Will you apply for a contractor’s license for construction work?
No
Yes
Is the business in the state limited to sales? If "Yes," answer a-d.
No
Yes
9.
a. Does any salesperson reside in the state?
No
Yes
b. Will any salesperson need WV Workers’ Comp. coverage?
No
Yes
c. Does your salesperson have authority to finalize a contract?
No
Yes
d. How are goods shipped to your customers?
Common Carrier
Company Vehicles
No, we plan on multiple jobs or on-going business.
10. Do you expect work to be limited to only one occasion
Yes, Beginning:
Ending:
of no more than one month?
11. Will you have employees, other than sales people, working within the state? If "Yes," answer a-c.
Yes
No
a. Will WV taxes be withheld?
No
Yes
b. Will they have WV Unemployment Coverage?
Yes
No
c. Will they have WV Workers' Compensation Coverage?
No
Yes
Continued on page 2 of this application.
Form CF-2
Issued by the Office of the Secretary of State
Revised 01/17
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