Form Ct 06115-0470 - Application For Registration Of Corporate Name
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1APPLICATION
FOR REGISTRATION
OF
CORPORATE
NAME
FOREIGN STOCK OR NON-STOCK
CORPORATION
Office of the Secretary of the State
30 Trinity Street / P.O. Box 150470 / Hartford, CT 06115-0470 / Rev. 12/1999
Space For Office Use Only
The undersigned
hereby applies for registration
of the following
corporate
name.
1. CORPORATE
NAME:
t2. STATE OR COUNTRY
OF INCORPORATION:
3
.
DATE OF INCORPORATION:
I
I
--
(mo./day/yr.)
4. THE NATURE
OF BUSINESS IN WHICH
THE CORPORATION
IS ENGAGED:
(Please reference an 8 l/2 X 11 attachment if additional
space is needed)
5. ADDRESS OF THE CORPORATION:
6. EXECUTION:
Dated this
day of
,20
.
I
I
Print or type name of signatory
1
Capacity
of signatory
Signature
INSTRUCTIONS:
Please return completed registration
form to the Office of the Secretary of the
State at the above referenced address.
The application
must be accompanied by an original Certificate of Existence issued by the
official keeper of corporate records in the state or country of the corporation’s
formation.
This Certificate may poJ be more than 90 davs old at the time of filing.
A registration
of corporate name expires at the end of the calendar year
in which an application is filed.
Please type or print all information
other than the signature.
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