Notification Statement For In-State
Business Entities Pursuant to
Chapter 112, Business &
Commerce Code
Form 3902 (Rev. 09/2017)
Submit in duplicate to:
Secretary of State
P.O. Box 13697
Austin, TX 78711-3697
512 463-5555
FAX: 512 463-5709
Filing Fee: No Fee
In-State Business Entity Information
1. The name of the in-state business entity is:
2. Name of contact person:
3. Mailing Address:
Street Address or P.O. Box City State Country Zip Code
Affiliate Information
1. The name of the affiliate entity is:
2. The affiliate was formed under the laws of:
3. The federal employer identification number of the affiliate is:
4. The address of the affiliate's principal office is:
Street Address City State Country Zip Code
5. The affiliate first entered Texas on the following date:
mm/dd/yyyy
6. Name of contact person:
7. Mailing Address:
Street Address or P.O. Box City State Country Zip Code
This space reserved for
office use
Form 3902 (Rev. 09/2017)
