Health Spa Consumer Protection Act
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Health Spa Consumer Protection Act Form. This is a Arkansas form and can be use in Miscellaneous Secretary Of State.
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Tags: Health Spa Consumer Protection Act, CFD-03, Arkansas Secretary Of State, Miscellaneous
Arkansas Secre t a ry of State
Charlie Daniels
State Capitol • Little Rock, Arkansas 72201-1094
501-682-3409 • www.sos.arkansas.gov
I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class
C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.
NOTE: Subsequent annual reports may be filed within thirty (30) days of the anniversary date of this filing.
Health Spa Consumer Protection Act
(Act 264 of 1989)
Annual Registration Statement
Date:
(Please Submit in Duplicate)
Name of Health Spa:
Street Address:
The name and addresses of all officers, directors and stockholders of the Health Spa as follows:
Name
Position Held
Address
(Attach separate list if necessary)
Name of Health Spa's parent corporation, if applicable:
Street Address:
The names and street addresses of all officers, directors and stockholders of the Health Spa's parent corporation are as follows:
Name
Position Held
Address
(Attach separate list if necessary)
The types of facilities available are as follows:
Name, street address and telephone number of a contact person responsible for filing annual registration:
NAME
(Signature of Contract Person)
STREET ADDRESS
(Telephone Number)
ADDRESS:
City
State
ZIP
CFD-03 Rev. 4/06
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