Form N-09 - Application For Certificate Of Authority For Nonprofit Corporation - 2000
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3State of North Carolina
Department of the Secretary of State
APPLICATION FOR CERTIFICATE OF AUTHORITY
FOR NONPROFIT CORPORATION
Pursuant to §55A-15-03 of the General Statutes of North Carolina, the undersigned corporation hereby applies for a Certificate of
Authority to conduct affairs in the State of North Carolina, and for that purpose submits the following:
1. The name of the corporation is ______________________________________________________________________________
and if that name is unavailable for use in the State of North Carolina, the name the corporation wishes
to use is: _______________________________________________________________________________________________
2. The state or country under whose laws the corporation was organized is:_____________________________________________
3. The date of incorporation was ____________ ; its period of duration is:______________________________________________
4. The street address of the principal office of the corporation is:
Number and Street________________________________________________________________________________________
City, State, Zip Code______________________________________________________________________________________
5. The mailing address if different from the street address of the principal office of the corporation is:
_______________________________________________________________________________________________________
6. The street address and county of the registered office in the State of North Carolina is:
Number and Street________________________________________________________________________________________
City, State, Zip Code________________________________________________ County: _______________________________
7. The mailing address if different from the street address of the registered office in the State of North Carolina is:
_______________________________________________________________________________________________________
8. The name of the registered agent in the State of North Carolina is:__________________________________________________
9. The names and usual business addresses of the current officers of the corporation are:
Name
Title
Business Address
Revised January 2000
Form N-09
CORPORATIONS DIVISION
P. O. BOX 29622
RALEIGH, NC 27626-0622
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