Foreign Statutory Trust Application For Certificate Of Authority - Wyoming Secretary Of State Page 3

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8. Names and business addresses of the current trustees:
Name:
Address:
9. The statutory trust company accepts the constitution of the state of Wyoming in compliance with the requirement
of Article 10, Section 5 of the Wyoming Constitution.
10. For name availability purposes list the type of business the statutory trust company will be conducting:
Trustee Signature: ____________________________________
Date:
( mm/dd/yyyy)
Print Name:
Contact Person:
Daytime Phone Number:
Email:
(Email provided will receive annual report reminders and filing evidence)
*May list multiple email addresses
REQUIRED ATTACHMENT TO INCLUDE WITH THE FILING
The completed application must be accompanied by an original certificate of existence/good standing,
dated not more than sixty (60) days prior to filing in Wyoming, duly authenticated by the Secretary of State
or other official having custody of corporate records in the state or country of formation.
Note:
An annual report will be due on or before January 2 each year. If not paid within thirty (30) days from the due
date the entity will become delinquent, increasing the annual report fee to $200. If not filed by April 1, the entity will
be subject to dissolution/revocation.
FST-CertificateAuthority - Revised October 2015

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