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.)
