Form F-01 - Application For Certificate Of Authority - 2007, Form Ft-11 - Corporate Franchise Tax - 2006 Page 2

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Arkansas Secretary of State
M
M
ark
artin
State Capitol • Little Rock, Arkansas 72201-1094
501-682-3409 •
Business & Commercial Services, 250 Victory Building, 1401 W. Capitol, Little Rock
CORPORATE FRANCHISE TAX
In order for this corporation to receive its annual corporate franchise tax reporting form,
please complete and file with the office of the Secretary of State at the time of incorporation
or qualification
.
Corporate name
Contact person
Street address or Post Office Box number
City, State, ZIP
Telephone number
E-mail address
NOTE: This tax is due on or before May 1 of the year following incorporation or qualification
in this state.
I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State
is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.
Authorized Officer (Type or Print)
Authorized Signature of Incorporator, Officer or Agent for the Corporation
FT-11 Rev. 4/06

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