CSCL/CD-274 (08/15)
Michigan Department of Licensing and Regulatory Affairs
Corporations, Securities & Commercial Licensing Bureau
Corporations Division
Business Services Section - (517) 241-6470
Fax: (517) 241-0538
FOR BUREAU USE ONLY
F HC Completed By
CERTIFICATION AND COPIES REQUEST
(Authorized by P.A. 284 of 1972, P.A. 162 of 1982, P.A. 213 of 1982, P.A. 23 of 1993, as amended)
Instructions: Orders being returned by fax may not exceed 18 pages.
Return by:
Mail
Fax #
( )
Only orders 18 pages or less will be returned by fax.
Requestor: (Must be completed to Process) Bill to: (if different)
Name Name
Attention Attention
Address Address
Address Address
ZIP CodeStateCity City ZIP CodeState
Telephone Number Telephone Number
( ) ( )
A.
Identification Number
B.
C.
D.
E.
Entity Name
DOCUMENTS:
U UNCERTIFIED - minimum fee is $6.00; seven pages or more $1.00 additional per page.
Original Documents ONLY - NO Amendments
Original Documents and ALL Amendments
Annual Report(s)/Statement(s) Specify year(s)
Other: filed
filed
Invoice Number
CERTIFICATE(S):
Status (LLC) - $10.00
Good Standing (Corporation and LLC) - $10.00
Not Cancelled (Limited Partnership) - $10.00
Certificate of Fact - Listing ALL documents filed - $50.00
Other Certificate of Fact - $20.00 - stating
LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with
disabilities.
CERTIFIED
- minimum fee is $16.00; seven pages or more $1.00 additional per page.
