Non-Refundable Processing Fee: $22.00
A Certificate of Good Standing/Existence from the state of organization dated no earlier than ninety (90) days prior to filing with the Division is attached.
1. Name of Association:
2. Purpose:
3. The name of the state/jurisdiction under whose law the foreign cooperative is organized:
4. Who/What is the name of the Registered Agent (Individual or Business Entity or Commercial Registered Agent)?:
____________________________________________________________________________________________
The address must be listed if you have a non-commercial registered agent. See instructions for further details.
Address of the Registered Agent: _______________________________________________________________
Utah Street Address Required, PO Boxes can be listed after the Street Address
City: State UT Zip:
5. Principal Office:
___________________________________________________________________________________
Address City State Zip
The duration of the company shall be ______ years. (may not exceed 99 years)
6. Duration
Opti
onal
The duration date of the company shall be _________________________________________ (usually perpetual)
7. Requirements: Name and Address of Officers and Directors: Must list current officers and directors (attach an additional page if needed)
If person holds more than 1 position, you may list the first position then use a slash to indicate multiple positions: ex. officer/director
1. __________________________________________________________________________________________ _______________________________________________________
Name
P
osition(s)
_________________________________________________________________________________________________________________________________
_____________________________
Address City State Zip
2. __________________________________________________________________________________________ _________________________________
______________________
Name
P
osition(s)
_________________________________________________________________________________________________________________________________
_____________________________
Address City State Zip
3. __________________________________________________________________________________________ _________________________________
______________________
Name
P
osition(s)
_________________________________________________________________________________________________________________________________
_____________________________
Address City State Zip
4. __________________________________________________________________________________________ _________________________________
______________________
Name
P
osition(s)
_________________________________________________________________________________________________________________________________
_____________________________
Address City State Zip
Under penalties of perjury, I declare that this Certificate of Authority has been examined by me and is, to the best of my knowledge and belief, true,
correct and complete.
Authorized Signer Signature: Title:
Under GRAMA {63G-2-201}, all reg
istration information maintained by the Division is classified as public record.
9. The Uniform Limited Cooperative Association shall use as its name in Utah:
____________________________________________________________________________________________
The Uniform Limited Cooperative Association shall use its name as set forth at the top of this form unless the name is not available for use in Utah.
Optional Inclusion of Ownership Information: This information is not required.
Is this a female owned business? Yes No
Is this a minority owned business? Yes No If yes, please specify:
State of Utah
Department of Commerce
Division of Corporations & Commercial Code
Certificate of Authority (Foreign Uniform Limited Cooperative Association)
This form cannot be hand written.
What is a commercial registered agent?
Select/Type the position here
Select/Type the position here
Select/Type the position here
Select/Type the position here
Sign here after the form is printed
Select/Type the race of the owner here
Mailing/Faxing Information:
www.corporations.utah.gov/contactus.html
www.corporations.utah.gov
