SOS GSSC check #___________ check date__________ check amount $____________
09/2013
REQUEST FOR
GOOD STANDING AND STATUS CERTIFICATES
(TYPE OR PRINT LEGIBLY)
□ Certificate of Good Standing
□ Regular Form
OR
□ Long Form (Includes historical Information)
□ Certificate of Status
The following fees apply for Certificate of Good Standing or Certificate of Status
FEES: Nonprofit $10.00
Cooperative $10.00
Limited Liability Company $25.00
Foreign Business Trust $25.00
Profit $50.00
□ Certificate of Non-existence / Non-registration $25.00
(an entity not on file with the Corporations Bureau)
EXACT ENTITY NAME:________________________________________________________________
ENTITY NUMBER:____________________________
REQUESTING PARTY
NAME _______________________________________
ADDRESS ____________________________________
CITY ___________________________ STATE _______
ZIP CODE ________ TELEPHONE #________________
EMAIL ADDRESS ______________________________
SIGNATURE __________________________________
Must be original signature
NOTE: The Secretary of State-Tax Compliance Section will research the file and advise the entity, in writing, of any delinquencies to include
corporate reports, if required, as well as a summary of fees due. Delinquent reports can be filed by utilizing our e-filing web portal.
