Form C-9021 - Application For Reinstatement Of Corporate Charter
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1C-9021
State of New Jersey - Division of Taxation
(10-99, R-4)
APPLICATION FOR REINSTATEMENT OF CORPORATE CHARTER
Mail To: State of New Jersey
Department of The Treasury
Division of Taxation
Corporate Services Audit Group
PO Box 277
Trenton, NJ 08695-0277
Fax To: Corporate Services Audit Group
(609) 292-3467
This form is to be used to permit the Director of the Division of Taxation to release information pertaining to the reinstatement of a
corporation’s charter to the authorized representatives of subject corporation. The following information is submitted in order to
avoid inordinate delays in the reinstatement process. Please type or print clearly.
Complete Name of Corporation:________________________________________________________________________________
Trade Name (if any):_________________________________________________________________________________________
Business Address: ___________________________________________________________________________________________
___________________________________________________________________________________________
Corporation Serial Number:____________________________________________________________________________________
Federal Identification Number: _________________________________________________________________________________
Date and State of Incorporation: ________________________________________________________________________________
Date Charter Declared Void: ___________________________________________________________________________________
Nature of Business: __________________________________________________________________________________________
Does Corporation hold Title to Real Estate? __________ If so, when acquired? _________________________________________
Does Corporation derive income from the rental of such property? ____________________________________________________
Corporation Status (check one):
ACTIVE
INACTIVE
Permission is hereby granted to release any information regarding the above corporation necessary to facilitate the reinstatement of
the corporation’s charter to the agent named below:
______________________________________________________
________________________________________________
Name
Relationship to Corporation
__________________________________________________________________________________________________________
No.
Street
__________________________________________________________________________________________________________
City
State
Zip Code
Telephone Number: (__________)___________________________
Ar
ea Code
Number
__________________________________________________________________________________________________________
Authorized Signature Corporate Officer
Title
Date
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