State Form 37035 - Application For Certificate Of Authority Foreign Nonprofit Corporation - 2016 Page 2
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1
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3APPLICATION FOR CERTIFICATE OF AUTHORITY
FOREIGN NONPROFIT CORPORATION
State Form 37035 (R11 / 6-16)
Approved by State Board of Accounts, 2016
Indiana Code 23-17-26-1
23-17-29-3
FILING FEE: $75.00
APPLICATION FOR CERTIFICATE OF AUTHORITY OF
__________________________________________________________________________________________________
A FOREIGN CORPORATION TO TRANSACT BUSINESS IN THE STATE OF INDIANA.
The undersigned officer, desiring to effectuate the admittance of the above Corporation to 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 cover page.)
ARTICLE II – ADDRESS OF PRINCIPAL OFFICE
Address of Principal Office (number and street )
City
State
ZIP code
ARTICLE III – REGISTERED OFFICE AND AGENT
Name of Registered Agent (Cannot be the corporation itself.)
Address of Registered Office (number and street or building – PO box not accepted)
City
State
ZIP code
IN
Required:
By checking the box, the Signator(s) represent(s) that the Registered Agent named in the application has consented to the appointment
of Registered Agent.
ARTICLE IV – DATE OF INCORPORATION AND DURATION OF EXISTENCE
Date of incorporation in domicilary 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): ________________________
ARTICLE V – TYPE OF CORPORATION (CHECK ONLY ONE.)
If the Corporation had been incorporated in Indiana, it would be a:
public benefit corporation, which is organized for a public or charitable purpose;
religious corporation, which is organized primarily or exclusively for religious purposes; or
mutual benefit corporation (all others).
ARTICLE VI – CORPORATE OFFICERS
List the names and business addresses of the officers of the Corporation. (Please attach additional sheets if necessary.)
Name
Title
Address (number and street, city, and state and ZIP code)
(Continued on the next page.)
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