Form N-09 - Application For Certificate Of Authority For Nonprofit Corporation - 2000 Page 3
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1
2
3Instructions for filing
APPLICATION FOR CERTIFICATE OF AUTHORITY
FOR NONPROFIT CORPORATION
(Form N-09)
Item 1
Enter the complete name of the corporation exactly as it appears in the records of the appropriate official in the state
or country of organization. If that name cannot be used in North Carolina, enter the name that it wishes to use in
North Carolina.
Item 2
Enter the state or country of incorporation.
Item 3
Enter the date of incorporation and the period of duration.
Item 4
Enter the complete street address of the corporation’s principal office.
Item 5
Enter the complete mailing address of the corporation’s principal office if different from the street address shown in
Item 4.
Item 6
Enter the complete street address of the corporation’s registered office and the county in which it is located.
Item 7
Enter the complete mailing address of the corporation’s registered office if different from the street address shown
in Item 6.
Item 8
Enter the name of the registered agent. The registered agent must be a North Carolina resident, an existing domestic
business or nonprofit corporation, or a foreign business or nonprofit corporation authorized to transact business or
conduct affairs in North Carolina.
Item 9
Enter the names, titles, and usual business addresses of the current officers of the corporation.
Item 10-12
See form.
Item 13
The document will be effective on the date and at the time of filing, unless a delayed date or an effective time (on
the day of filing) is specified. If a delayed effective date is specified without a time, the document will be effective
at 11:59:59 p.m. Raleigh, North Carolina time on the day specified. If a delayed effective date is specified with a
time, the document will be effective on the day and at the time specified. A delayed effective date may be specified
th
up to and including the 90
day after the day of filing.
Date and Execution
Enter the date the document was executed.
In the blanks provided enter:
•
The name of the corporation as it appears in item 1.
•
The signature of the representative of the corporation executing the document (may be the presiding
officer of the board of directors or any officer of the corporation).
•
The name and title of the above-signed representative.
Revised January 2000
Form N-09
CORPORATIONS DIVISION
P. O. BOX 29622
RALEIGH, NC 27626-0622
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