Statement Of Foreign Entity Authority Sample Form
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1
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3Document must be filed electronically.
Paper documents will not be accepted.
This copy is furnished as a sample
and may not be submitted for filing.
Submitting this form on paper
will result in rejection of the form.
Forms can be found online at the
File a Document page.
Statement of Foreign Entity Authority
filed pursuant to
§ 7-90-803
of the Colorado Revised Statutes (C.R.S.)
1. The entity ID number, the entity name, and the true name, if different, are
Entity ID number
______________________________________________________
(Colorado Secretary of State ID number)
Entity name
______________________________________________________
True name
______________________________________________________.
(if different from the entity name)
2. The form of entity and the jurisdiction under the law of which the entity is formed are
Form of entity
______________________________________________________
Jurisdiction
______________________________________________________.
3. The principal office address of the entity’s principal office is
Street
address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________
(Province – if applicable)
(Country)
Mailing
address
______________________________________________________
(leave blank if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________.
(Province – if applicable)
(Country)
4. The registered agent name and registered agent address of the entity’s registered agent are
Name
(if an individual)
____________________ ______________ ______________ _____
(Last)
(First)
(Middle)
(Suffix)
OR
(if an entity)
______________________________________________________
(Caution: Do not provide both an individual and an entity name.)
AUTHORITY
Page 1 of 3
Rev. 6/28/2011
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