Application For Certificate Of Authority {CORP-1(F)}

Business ID: Vermont Secretary of State APPLICATION FOR CERTIFICATE OF AUTHORITY of a non-Vermont Corporation (profit, nonprofit, or cooperative) seeking to do business in the state of Vermont PLEASE RETURN ACKNOWLEDGEMENT TO: (REQUIRED - NAME AND ADDRESS) NAME ADDRESS Processed by: FOR OFFICE USE ONLY THIS DOCUMENT MUST BE TYPEWRITTEN OR PRINTED (11A V.S.A. § 1.20) PLEASE REVIEW INSTRUCTIONS PAGE BEFORE BEGINNING 1. FOREIGN CORPORATION: REQUIRED ­ BUSINESS NAME MUST INCLUDE, OR ADD FOR USE IN VERMONT, ONE OF THE FOLLOWING CORPORATE IDENTIFIERS: "CORPORATION," "INCORPORATED," "COMPANY," "LIMITED," "PROFESSIONAL ASSOCIATION;" OR ABBREVIATIONS "CORP," "INC," "CO," "LTD," "PC," "PA," OR "SC," BUSINESS NAME: 2. BUSINESS TYPE: REQUIRED ­SELECT ONE (1) OF THE FOLLOWING This is a profit corporation. This is a nonprofit corporation. 3. BUSINESS INFORMATION: a. b. c. d. FISCAL YEAR END MONTH: OPTIONAL ­ PROFIT CORPORATIONS ONLY (DECEMBER WILL BE ENTERED IF NOT PROVIDED) - PROFIT CORPORATION ANNUAL REPORTS ARE DUE EACH YEAR WITHIN THE 2.5 MONTH PERIOD FOLLOWING THE FISCAL YEAR END ON RECORD - NONPROFIT CORPORATION BIENNIAL REPORTS ARE DUE EVERY 2 YEARS BETWEEN JANUARY 1ST & APRIL 1ST BEGINNING THE FIRST YEAR FOLLOWING QUALIFICATION BUSINESS DESCRIPTION: REQUIRED - NAICS CODE (PREFERRED) OR BRIEF STATEMENT OF PRIMARY SERVICE(S) TO BE PROVIDED BY THIS CORPORATION BUSINESS DESCRIPTION: DATE OF INCORPORATION IN STATE OF INCORPORATION: REQUIRED BUSINESS EMAIL ADDRESS: OPTIONAL PHYSICAL BUSINESS OFFICE ADDRESS: NO PO BOX City/Town: Country: State/Province: ZIP/Postal Code: - 4. PRINCIPAL OFFICE INFORMATION: REQUIRED a. b. MAILING ADDRESS: City/Town: Country: State/Province: ZIP/Postal Code: - 5. INITIAL REGISTERED AGENT: REQUIRED ­ THIS CORPORATION'S DESIGNATED POINT OF CONTACT IN THE STATE OF VERMONT a. b. NAME: PHYSICAL BUSINESS ADDRESS: AGENT'S REGULAR LOCATION DURING NORMAL BUSINESS HOURS. Street Address: NO PO BOX City/Town: State: VT VT ZIP: - c. d. MAILING ADDRESS: City/Town: State: ZIP: - EMAIL: REQUIRED - MUST ATTACH A CERTIFICATE OF GOOD STANDING (OR EQUIVALENT), AUTHENTICATED BY THE SECRETARY OF STATE OR OTHER OFFICIAL HAVING CUSTODY OF BUSINESS RECORDS IN THE STATE OR COUNTRY UNDER WHOSE LAW THIS CORPORATION IS ORGANIZED, DATED NO EARLIER THAN 30 DAYS PRIOR TO THE FILING OF THE APPLICATION. 6. STATE OF INCORPORATION: REQUIRED- US STATE or NON-US COUNTRY 7. CURRENT DIRECTOR(S) REQUIRED ­ MINIMUM OF 1 a. NAME Address: City/Town: Country: State/Province: ZIP/Postal Code: - 11A V.S.A. § 15.03/11B V.S.A. § 15.03 (REV. 07/01/15) American LegalNet, Inc. www.FormsWorkFlow.com DIVISION OF CORPORATIONS Page 1 of 2 FORM CORP-1(F) CORPORATION REGISTRATION (FOREIGN) This page intentionally left blank. (Reverse of Page 1 of 2) American LegalNet, Inc. www.FormsWorkFlow.com Vermont Secretary of State APPLICATION FOR CERTIFICATE OF AUTHORITY of a non-Vermont Corporation (profit, nonprofit, or cooperative) seeking to do business in the state of Vermont b. NAME: Address: City/Town: Country: State/Province: ZIP/Postal Code: - c. NAME: Address: City/Town: State/Province: ZIP/Postal Code: - Country: CHECK IF APPLICABLE: This corporation has more than three (3) directors. IF SELECTED - MUST ATTACH A COMPLETE LIST OF ADDITIONAL DIRECTORS. 8. CURRENT OFFICER(S) OPTIONAL­ IF ANY a. PRESIDENT: Address: City/Town: Country: State/Province: ZIP/Postal Code: - b. VICE PRESIDENT: Address: City/Town: Country: State/Province: ZIP/Postal Code: - c. SECRETARY: Address: City/Town: Country: State/Province: ZIP/Postal Code: - d. TREASURER: Address: City/Town: State/Province: ZIP/Postal Code: IF SELECTED - MUST ATTACH A COMPLETE LIST OF ADDITIONAL OFFICERS. - Country: CHECK IF APPLICABLE: This corporation has more than four (4) Officers. 9. a. NONPROFIT SUB-TYPES REQUIRED ­ NONPROFITS ONLY MEMBER ORGANIZATION STATUS: REQUIRED ­SELECT ONE (1) OF THE FOLLOWING This Nonprofit is a member organization. This Nonprofit is not a member organization. BENEFIT TYPE: REQUIRED ­SELECT ONE (1) OF THE FOLLOWING This Nonprofit would be a public benefit corporation as defined in 11B V.S.A. § 17.05, if it had been initially formed in Vermont. This Nonprofit would be a mutual benefit corporation as defined in 11B V.S.A. § 17.05, if it had been initially formed in Vermont. MAY BE POST-DATED UP TO 90 DAYS FROM DATE OF RECEIPT b. 10. EFFECTIVE DATE: OPTIONAL CERTIFICATION OF DOCUMENT: REQUIRED I hereby certify, under penalty of law, (11A/B V.S.A. §1.29), as a director or officer listed above (under lines 7 or 8), that the above information is accurate; and that this document is provided in duplicate with a Check or Money Order, payable to "VT SOS," in the amount of $125.00. Printed Name of Director or Officer Signature of Director or Officer PLEASE REVIEW INSTRUCTIONS ON REVERSE BEFORE FILING. Date 11A V.S.A. § 15.03/11B V.S.A. § 15.03 (REV. 07/01/15) American LegalNet, Inc. www.FormsWorkFlow.com DIVISION OF CORPORATIONS Page 2 of 2 FORM CORP-1(F) CORPORATION REGISTRATION (FOREIGN) Vermont Secretary of State APPLICATION FOR CERTIFICATE OF AUTHORITY of a non-Vermont Corporation (profit, nonprofit, or cooperative) seeking to do business in the state of Vermont SUBMISSION INSTRUCTIONS a. THIS FORM must be filed in duplicate (1 original + 1 copy ­or-- 2 originals) with a Certificate of Good Standing (or equivalent instrument), a check or money order, payable to "VT SOS," in the amount of $125.00, and a self-addressed stamped envelope. b. THIS FORM can ONLY be accepted by Mail or In-person at: Vermont Secretary of State Corporations Division 128 State Street Montpelier, VT 05633-1104 c. Please allow 7-10 business days, or more, from the day that THIS FORM is received in our office, for processing and (if approved) for this business to appear on the website at www.vtsosonline.com, and for evidence of filing to be returned. ***THIS FILING IS NOW AVAILABLE ONLINE*** THIS FORM CANNOT be accepted by Phone, Fax, or E-mail; however, this filing is now available online: - If you wish to submit this filing electronically, DO NOT fill out THIS FORM, please file online at https://www.vtsosonline.com/online/Account?referrer=BF. Payment for THIS FORM also CANNOT be accepted by credit card or e-check (ACH); however, payment by credit card or e-check (ACH) is available by filing online: - If you wish to submit payment by credit card or e-check (ACH), DO NOT fill out THIS FORM, please file online at https://www.vtsosonline.com/online/Account?referrer=BF. Onli