Application Form For Certificate Of Authority Foreign Limited Cooperative Association
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1
2APPLICATION FOR CERTIFICATE
OF AUTHORITY
LIMITED COOPERATIVE ASSOCIATION
(FOREIGN)
Submit in Duplicate
John A. Gale, Secretary of State
Room 1301 State Capitol, P.O. Box 94608
Lincoln, NE 68509
(402) 471-4079
An original certificate of good standing or existence from the state or country of organization
executed by the official having custody of such records must be filed with this application.
NOTE: A certified copy of the company's articles of organization may not be filed in lieu of a
certificate of good standing or existence.
Name of Limited Cooperative Association __________________________________
_____________________________________________________________________
Alternative Name ______________________________________________________
(only used when the associations name does not comply with Neb. Rev. Stat. 21-2908)
Organized under the laws of the State/Jurisdiction of _________________________
Address of Designated office in this state:
____________________________________________________NE_________________
Street and Mailing Address
City
State
Zip
Address of Designated office in state of organization IF such address is required by state
of organization:
_____________________________________________________________________
Street and Mailing Address
City
State
Zip
Name and address of registered agent in Nebraska:
Registered Agent Name:__________________________________________________
Address: _____________________________________________NE______________
Street and Mailing Address
City
Zip
____________________________________
_________________________________
Signature of Officer or Authorized Representative
Printed name of Officer or Authorized Representative
FILING FEE: For Profit $145.00 plus $5.00 per page for any additional pages
Not for Profit $25.00 plus $5.00 per page for any additional pages
1/1/2008
Neb. Rev. Stat.21-29,
103
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