State Form 38784 - Application For Certificate Of Authority Of A Foreign Corporation
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APPLICATION FOR CERTIFICATE OF
CONNIE LAWSON
SECRETARY OF STATE
AUTHORITY OF A FOREIGN CORPORATION
BUSINESS SERVICES DIVISION
State Form 38784 (R12 / 5-14) Corporate Form 112
302 W. Washington Street, E018
Approved by State Board of Accounts, 2014
Indianapolis, IN 46204
T elephone: (317) 232-6576
1. Use 8 1/2" x 11" white paper for attachments.
INSTRUCTIONS:
Indiana Code 23-1-49-1
23-1-49-3
2. Present original and one copy to address in the upper right corner of this form.
3. Please TYPE or PRINT in INK.
FILING FEE: $90.00
4. Please visit our office at
5. Make check or money order payable to Secretary of State.
NOTES:
1. Applicant must submit a certificate of existence issued by the proper authority within the last sixty (60) days.
2. If using a fictitious name, a copy of the resolution must accompany this filing. See Indiana Code 23-1-49-6(a)(2).
APPLICATION FOR CERTIFICATE OF AUTHORITY
OF
A FOREIGN CORPORATION TO TRANSACT BUSINESS IN THE STATE OF INDIANA.
The undersigned officer of the above corporation which was formed as:
A general business corporation
A professional corporation (must include a Certificate of Registration.)
desiring to effectuate the admittance of the above Corporation transact business in the State of Indiana, certifies the following facts:
ARTICLE I - NAME
Fictitious Name (Only used if name in the application is not available in Indiana.) (See Note 2 above.)
ARTICLE II - PRINCIPAL OFFICE ADDRESS
Address of Principal Office (number and street)
City
State
ZIP code
ARTICLE III - REGISTERED OFFICE AND REGISTERED AGENT
Name of Registered Agent (Cannot be the corporation itself)
Address of Registered Office (number and street) (PO Box not accepted)
City
State
ZIP code
IN
Required:
By checking the box, the Signator(s) represents that the registered agent named in the application has consented to the appointment
of registered agent.
ARTICLE IV- DATE AND STATE OF INCORPORATION AND DURATION OF EXISTENCE
The date of incorporation in domicilliary state (month, day, year)
State of incorporation
The Corporation is perpetual until dissolution.
OR
The latest date upon which the Corporation is to dissolve (month, day, year):
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