Brian P. Kemp
Secretary of State
OFFICE OF SECRETARY OF STATE
CORPORATIONS DIVISION
2 Martin Luther King Jr. Dr. SE
Suite 313 West Tower
Atlanta, Georgia 30334
(404) 656-2817
sos.georgia.gov/corporations
APPLICATION FOR CERTIFICATE OF AUTHORITY
FOR FOREIGN CORPORATION
IMPORTANT
Provide your e-mail address when completing this form.
E-Mail:
NOTICE TO APPLICANT: PRINT PLAINLY OR TYPE REMAINDER OF THIS FORM
1.
Name of Corporation Name Reservation Number (Optional)
Date business commenced (or proposed to commence) in Georgia:
(NOTE: If the date provided here is more than 30 days prior to the date the application is received by the Secretary of State, a $500 penalty must be paid. Penalty is statutory
and cannot be waived by Secretary of State.)
2.
Name of Filing Person Telephone Number
Address City State Zip Code
3.
Principal Office Mailing Address (may be P.O. Box) City State Zip Code
4.
Name of Registered Agent in Georgia
Registered Office Street Address in Georgia (post office box or mail drop not acceptable for registered office address)
GA
City County State Zip Code
5.
Corporation’s Name in State or Country of Incorporation (Must match name on certificate of existence)
Check ONE:
Jurisdiction (Home State or Country):
Date of Incorporation in Home Jurisdiction:
PROFIT NONPROFIT
6.
Officer / CEO Address City State Zip Code
Officer / CFO Address City State Zip Code
Officer / Secretary Address City State Zip Code
7. Effective Date: (Choose one) Upon filing Delayed effective date and/or time:
(A delayed effective date must be within 90 days of the filing date.)
8. NOTICE: Mail the following items to the Secretary of State at the above address.
(1) This
application;
(2) An ORIGINAL certificate of existence or good standing, not more than 90 days old, certified by the home state or country. (Certificate
from home state may not be more than 90 days old; copy of articles of incorporation from home state should NOT be submitted.); and
(3) Filing fee of $225.00 payable to
“Secretary
of State.” Filing fees are non
-refundable.
(4) If applicable, a copy of the resolution of the board of directors, certified by corporation’s secretary, adopting a fictitious or trade name.
Signature of Authorized Person Date
Print name Title
FORM 236
(Rev. 4/2015)
