Form Scc759/921 - Application For A Certificate Of Authority To Transact Business In Virginia - 1997

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SCC759/921
APPLICATION FOR A CERTIFICATE OF AUTHORITY
(04/97)
TO TRANSACT BUSINESS IN VIRGINIA
NOTE: THIS IS AN SCC APPROVED FORM. IT MAY BE DUPLICATED, BUT THE CONTENT AND FORMAT
CANNOT BE CHANGED.
Name of the corporation (include any "for use in Virginia" name):
_________________________________________________________________________
State or country of incorporation _______________________________________________
Date of incorporation _______________________ Period of duration __________________
Corporation's principal office address:
_________________________________________________________________________
(Number and street)
_________________________________________________________________________
(City or Town)
(State)
(Zip Code)
Name of the VIRGINIA registered agent: _________________________________________
The registered agent is (mark appropriate box[es]):
(1) An individual who is a resident of Virginia and
[ ] an officer of the corporation
[ ] a director of the corporation
[ ] a member of the Virginia State Bar
OR
(2)
[ ] A professional corporation or professional limited liability company of attorneys registered under §
54.1-3902, Code of Va.
Street address of the VIRGINIA registered office of the corporation:
_________________________________________________________________________
(Number and street)
__________________________________________________ VA ___________________
(City or Town)
(Zip Code)
The corporation's registered office in Virginia is located
in the [ ] City or [ ] County of ___________________________________________.
OFFICERS
NAME AND TITLE
BUSINESS ADDRESS
_____________________________
__________________________________________
__________________________________________
_____________________________
__________________________________________
__________________________________________
DIRECTORS
NAME
BUSINESS ADDRESS
_____________________________
__________________________________________
__________________________________________
_____________________________
__________________________________________
__________________________________________
STOCK
NO. OF SHARES AUTHORIZED
CLASS AND SERIES
__________________________
__________________________________________
__________________________
__________________________________________
The undersigned executes this application in the name of the corporation and declares the facts stated herein to be true:
_________________________________________________________________________
(Signature)
(Printed name and corporate title)
(Date)
See instructions on the reverse

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