Arkansas Secretary of State
M
M
ark
artin
State Capitol • Little Rock, Arkansas 72201-1094
501-682-3409 •
Business & Commercial Services, 250 Victory Building, 1401 W. Capitol, Little Rock
Application for Certificate of Authority
(Please type or print)
Pursuant to the provisions of the Business Corporation Act of 1987, Act 958 of 1987, the undersigned as the duly authorized and
acting president, secretary, treasurer, superintendent or managing agent in the State of Arkansas, of the foreign corporation
named below (the "corporation") for which this statement is submitted, under oath hereby states:
1a. The name of the corporation is:
1b. Fictitious name to be used in Arkansas:
(The corporation may use a fictitious name to transact business in Arkansas if its real name is unavailable and it delivers to the
Secretary of State for filing a copy of the resolution of its board of directors certified by its secretary adopting a fictitious name.)
2. The state, territory or foreign country under whose laws the corporation was incorporated is:
Date Incorporated:
Period of Duration:
3. The nature of the business of the corporation and the object or purposes to be transacted, promoted or carried on by it are:
4. The address of the general office or place of business of the corporation in Arkansas is designated to be:
(Street at Address)
(City)
(State)
(ZIP)
5. The name and address of the registered agent of the corporation upon whom Service of Process is authorized to be made in Arkansas is:
(Name)
(Street at Address)
(City)
(State)
(ZIP)
6. The address of the general office or principal place of business of the corporation is:
(Street at Address)
(City)
(State)
(ZIP)
7. The number and par value, if any, of shares of the corporation's capital stock owned or to be owned by residents of Arkansas:
Number of shares:
Par value of shares:
8. The foreign corporation shall deliver with the completed application a certificate of existence (or document of similar import) duly authorized
by the Secretary of State or other official having custody of corporate records in the state or country under whose laws it is incorporated.
9. A filing fee of $300.00 is submitted herewith in accordance with Act 958 of 1987.
Witness the hand and seal of the corporation executed under oath by the undersigned in behalf of the corporation on this the
day of
,
.
10. I understand that knowingly signing a false document with the intent to file it with the Arkansas Secretary of State is a
Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.
Witness the hand executed under oath by the undersigned in behalf of the corporation on this the __________ day
of __________________ , ______________.
(Name of Corporation)
(Signature of Authorized Officer)
Fee $300.00
payable to Arkansas Secretary of State
F-01/Rev. 1/07
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