SECRETARY OF THE STATE OF CONNECTICUT
MAILING ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, P.O. BOX 150470, HARTFORD, CT 06115-0470
DELIVERY ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, 30 TRINITY STREET, HARTFORD, CT 06106
PHONE: 860-509-6002 WEBSITE: www.concord-sots.ct.gov FAX: 860-509-6057
REQUEST FOR COPIES
USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. ATTACH 81/2 X 11 SHEETS IF NECESSARY.
FILING PARTY (Confirmation / Cop(ies) Will Be Sent To This Address):
NAME:
ADDRESS:
ZIP: CITY:
TELEPHONE
:
STATE:
FINANCIAL UNIT USE ONLY
AMT. REC’D $
CA CR
TRANS. ID:
BATCH DATE:
BUSINESS NAME (Enter Name Exactly As It Appears On Our Records):
FEES (completed within 3-5 business days):
Certified Copy - $55.00 each
Plain Copy - $40.00 each
Copies Will Be Mailed
FEES (completed within 24 business hours):
Expedited Certified Copy - $105.00 each
Expedited Plain Copy - $90.00 each
Copies Will Be Mailed
TYPE OF DOCUMENT
(e.g. Certificate of Incorporation)
FILING NUMBER or DATE OF FILING
TYPE OF COPY / NUMBER OF COPIES
Certified Copy _____ x 55.00=$________
Plain Copy _____ x 40.00=$________
Certified Copy _____ x 55.00=$________
Plain Copy _____ x 40.00=$________
Certified Copy _____ x 55.00=$________
Plain Copy _____ x 40.00=$________
FOR ADDITIONAL REQUESTS, INCLUDE 8 ½ X 11 SHEETS OR SCREEN PRINT FROM WEBSITE.
(OPTIONAL) Expedited Service – Total Number of Copies Requested _____ x 50.00 = $_____________
Grand Total $_____________
PAYMENT METHODS (Choose One):
☐Make checks payable to “Secretary of the State”.
☐Payment by an existing Customer ID: ________________________________
☐To fax this request you must complete the following Credit Card Payment Authorization to 860-509-6057.
AMOUNT AUTHORIZED: $_________________
CREDIT CARD BILLING INFORMATION (Failure to provide ALL Required credit card information will result in delay of processing):
NAME:
ADDRESS:
CITY:
STATE: ZIP:
CARD NO.:
EXPIRATION DATE:
SECURITY CODE:
SIGNATURE: X______________________________________
PAGE 1 OF 1
FORM CXC-1-1.0
Rev. 12/2017
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