Form Va-1 - Application For Voluntary Association Page 3
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4Natalie E. Tennant
P
enney Barker, Manager
Corporations Division
Secretary of State
State Capitol, W-139
Tel: (304) 558-8000 Fax 304 558-8381
1900 Kanawha Blvd. East
Hrs: 8:30 am - 5:00 pm ET
Charleston, WV 25305-0770
FILE ONE ORIGINAL APPLICATION
APPLICATION FOR
And one original copy of the declaration,
VOLUNTARY ASSOCIATION
articles or agreement of trust creating
the association (opt'l for WV associations)
1.
The name of the Voluntary Association shall be:
If the Association is formed under the laws of another
1A
state,list the State of its formation and the formation date:
Street:
2.
The principal office address of the
association will be:
City/State/Zip:
located in the County of:
County:
The mailing address of the voluntary
Street/Box:
association, if different, will be:
City/State/Zip:
3.
The name and address of the
N a m e :
person to whom notice of
process may be sent, if any, is:
Street:
City/State/Zip:
4.
This voluntary association is organized as: (check one below)
NON-PROFIT
FOR PROFIT
5.
The purpose of the voluntary association is:
6.
The name and address of one or more of the organizers of the association:
7.
The names and addresses of the officers, owners or members of the voluntary association who have authority to
sign documents are (at least two must be listed):
FORM VA-1
Issued by the WV Secretary of State, State Capitol, Charleston, WV 25305
Revised 1/09
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