APPLICATION FOR CERTIFICATE OF AUTHORITY
FOREIGN FOR-PROFIT CORPORATION
State Form 38784 (R14 / 6-16)
Approved by State Board of Accounts, 2016
SECRETARY OF STATE
BUSINESS SERVICES DIVISION
302 West Washington Street, Room E018
Indianapolis, IN 46204
Telephone: (317) 232-6576
www.sos.in.gov
INSTRUCTIONS: 1. Use 8 ½”x11 white paper for attachments.
2. Please TYPE
or PRINT in INK.
3. Please visit our office at www.sos.IN.gov
4. Make check or money order payable to the Secretary of State.
5. Submit original completed paperwork to: 302 West Washington Street, Room E-018, Indianapolis, IN 46204.
REQUIREMENTS: 1. Applicant must submit a certificate of existence issued by the proper authority within the last sixty (60) days.
2. If using a fictitious name, a copy of the resolution MUST accompany this filing. See Indiana Code 23-1-49-6(a)(2).
INFORMATION CONTAINED ON THIS PAGE IS NOT PART OF THE PUBLIC RECORD.
Name of business
E-mail address of business (SOS use only)
RETURN DOCUMENTS TO:
Name
Street address, line 1
Street address, line 2
City
State
ZIP code
Telephone number
( )
E-mail address (If different from above – SOS use only)
Reset Form
APPLICATION FOR CERTIFICATE OF AUTHORITY
FOREIGN FOR-PROFIT CORPORATION
State Form 38784 (R14 / 6-16)
Approved by State Board of Accounts, 2016
Indiana Code 23-1-49-1
23-1-49-3
23-1-18-3
FILING FEE: $125.00
APPLICATION FOR CERTIFICATE OF AUTHORITY OF
__________________________________________________________________________________________________
A FOREIGN CORPORATION TO TRANSACT BUSINESS IN THE STATE OF INDIANA.
The undersigned officer of the above corporation, which was formed as:
a general business corporation, a professional corporation, (must include a Certificate of Registration.)
desiring to effectuate the admittance of the above Corporation to transact business in the State of Indiana, certifies the following facts:
ARTICLE I – NAME
Fictitious Name (Only used if name in the application is not available in Indiana.) (See cover page.)
ARTICLE II – ADDRESS OF PRINCIPAL OFFICE
Address of Principal Office (number and street)
City
State
ZIP code
ARTICLE III – REGISTERED OFFICE AND AGENT
Name of Registered Agent (Cannot be the corporation itself.)
Address of Registered Office (number and street – PO box not accepted)
City
State
IN
ZIP code
Required:
By checking the box, the Signator(s) represent(s) that the Registered Agent named in the application has consented to the appointment
of Registered Agent.
ARTICLE IV – DATE OF INCORPORATION AND DURATION OF EXISTENCE
Date of incorporation in domicilary state (month, day, year)
State of incorporation
The Corporation is perpetual until dissolution.
OR
The latest date upon which the Corporation is to dissolve (month, day, year): ________________________
ARTICLE V – CORPORATE OFFICERS
List the names and business addresses of the officers of the Corporation. (Please attach additional sheets if necessary.)
Name Title Address (number and street, city, and state and ZIP code)
(Continued on the next page.)
ARTICLE VI – BOARD OF DIRECTORS
The names and business addresses of the Board of Directors of the Corporation are as follows: (Please attach additional sheets if necessary.)
By checking the box, the Signator(s) represents that the Corporation named in Article 1 is not required to have a Board of Directors
in its domicilary state.
Name Address (number and street, city, and state and ZIP code)
SIGNATURE
In witness whereof, the undersigned being the ___________________________________________________________ of said Corporation signs
(Title: Officer or Chairman or Board)
this Application for Certificate of Authority, and verifies subject to penalties of perjury, that the facts contained herein are true,
this ______ day of ________________________, 20______.
Signature Printed name