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: 860-509-6003 WEBSITE: www.concord-sots.ct.gov APPLICATION FOR CERTIFICATE OF AUTHORITY FOREIGN CORPORATION USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. ATTACH 81/2 X 11 SHEETS IF NECESSARY. FILING PARTY (CONFIRMATION WILL BE SENT TO THIS ADDRESS): FILING FEE: $385.00 EXCEPTION: $40.00 FILING FEE FOR NONSTOCK (NONPROFIT) CORPORATIONS. MAKE CHECKS PAYABLE TO "SECRETARY OF THE STATE" NAME: ADDRESS: CITY: STATE: ZIP: 1. NAME OF CORPORATION IN ITS STATE OR COUNTRY OF FORMATION: 2. THE CORPORATION'S NAME IS NOT AVAILABLE FOR USE IN CONNECTICUT. THE CORPORATION SHALL, THEREFORE, TRANSACT BUSINESS IN CONNECTICUT UNDER THE FOLLOWING NAME: (COMPLETE ONLY IF THE NAME OF THE CORPORATION IS NOT AVAILABLE FOR USE IN CONNECTICUT) 3. CHECK EITHER A OR B: A. THE CORPORATION IS ORGANIZED FOR PROFIT. 4. STATE/COUNTRY OF INCORPORATION: B. THE CORPORATION IS NONPROFIT. 5. DATE OF INCORPORATION: 6. DURATION: (CHECK ONE) PERPETUAL OTHER (SPECIFY) 7. DATE CORPORATION BEGAN TRANSACTING BUSINESS/CONDUCTING AFFAIRS IN CONNECTICUT: (MM,DD,YYYY) 8. PRINCIPAL OFFICE ADDRESS OF THE CORPORATION: ADDRESS: 9. MAILING ADDRESS OF THE CORPORATION: ADDRESS: CITY: STATE: ZIP: CITY: STATE: ZIP: PAGE 1 OF 3 FORM CFAS-1-1.0 Rev. 1/1/2015 American LegalNet, Inc. www.FormsWorkFlow.com 10. OFFICERS NAME TITLE RESIDENCE ADDRESS BUSINESS ADDRESS NOTE: IF ADDITIONAL SPACE IS NEEDED, PLEASE REFERENCE AN 8 1/2 X 11 ATTACHMENT 11. DIRECTORS NAME RESIDENCE ADDRESS BUSINESS ADDRESS 12. APPOINTMENT OF REGISTERED AGENT FOR SERVICE OF PROCESS: (CHECK A OR COMPLETE B) A. THE CORPORATION APPOINTS THE SECRETARY OF THE STATE OF CONNECTICUT AND HIS SUCCESSORS IN OFFICE TO BE ITS AGENT UPON WHOM ANY PROCESS, IN ANY ACTION OR PROCEEDING AGAINST IT, MAY BE SERVED B. PRINT OR TYPE NAME OF AGENT PAGE 2 OF 3 FORM CFAS-1-1.0 Rev. 1/1/2015 American LegalNet, Inc. www.FormsWorkFlow.com BUSINESS ADDRESS: (P.O.BOX UNACCEPTABLE) ADDRESS: RESIDENCE ADDRESS: (P.O.BOX UNACCEPTABLE) ADDRESS: CITY: STATE: ZIP: CITY: STATE: ZIP: ACCEPTANCE OF APPOINTMENT: (SIGNATURE OF AGENT) 13. CORPORATION EMAIL ADDRESS: REQUIRED. (If none, must state "NONE".) 14. EXECUTION: (SUBJECT TO PENALTY OF FALSE STATEMENT) DATED THIS DAY , 20 NAME OF SIGNATORY (print or type) CAPACITY/TITLE OF SIGNATORY SIGNATURE PAGE 3 OF 3 FORM CFAS-1-1.0 Rev. 1/1/2015 American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION FOR A CERTIFICATE OF AUTHORITY FOREIGN CORPORATION Filing Fee: $385.00 STOCK $40.00 NON-STOCK A foreign corporation desiring to transact business in Connecticut may obtain a certificate of authority by filing the Application for Certificate of Authority. The Application includes an appointment of the registered agent. A certificate of the corporation's legal existence (some states refer to this as a certificate of good standing) from the state of incorporation, authenticated by a proper officer of that state, must accompany the Application for Certificate of Authority. Such certificate must be received within 90 days from the date of issuance. Please note that the name of the foreign corporation filing an application for a certificate of authority must contain a word or words of corporate designation, even if the laws of its state of incorporation do not so require. If specific words or abbreviations are regarded as corporate designations in a foreign language, the filing must be accompanied by a legal opinion stating that fact. Documents submitted in any language other than English require an English translation. FAILURE TO PROVIDE ANY OF THE ABOVE INFORMATION WILL RESULT IN THE REJECTION OF THE DOCUMENT. Also, the foreign corporation's name must be distinguishable from the name of another active business on our records; when it is not, the corporation may adopt for use in this state a fictitious name. The fictitious name must be distinguishable from other business names on record and must contain a word or words of corporate designation, such as "incorporated" or an abbreviation such as "corp". If the corporation wishes to adopt a fictitious name for use in Connecticut, it must present for filing a resolution by its board of directors, certified by its secretary, adopting the fictitious name along with its Application for Certificate of Authority. Please also note the following information relating to the use of a fictitious name: a fictitious name may only be used by a foreign corporation when its real name is unavailable for use in Connecticut; once the real name of the corporation becomes available, the fictitious name may no longer be used; the corporation may not amend its certificate of authority to change a fictitious name; if a fictitious name is used, the corporation will be indexed on our records under that name and no other. In the event a foreign corporation holding a certificate of authority changes its corporate name, place of incorporation, or the period of its duration, it must apply for an amended certificate of authority. Please contact the Department of Revenue Services or your tax advisor as to any potential tax liability relating to your business. MAKE CHECKS PAYABLE TO THE SECRETARY OF THE STATE INSTRUCTIONS DO NOT SCAN THIS PAGE FORM CFAS-1-1.0 Rev. 1/1/2015 American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS 1. NAME OF CORPORATION IN STATE OR COUNTRY OF FORMATION: Please provide the name of the corporation as it appears on the certificate of legal existence submitted with the application. 2. IF NAME PROVIDED IN NUMBER 1 ABOVE IS NOT AVAILABLE FOR USE IN CONNECTICUT, THE NAME UNDER WHICH CORPORATION SHALL TRANSACT BUSINESS IN CONNECTICUT: If the corporation's name is not available, please provide a name (which may be a fictitious name) that shall be used in the state of Connecticut and which must be distinguishable from all other business names on record at the Office of the Secretary of the State. 3. CHECK EITHER A. OR B.: Place a check on the appropriate line to designate whether the corporation is organized for profit or nonprofit. 4. STATE/COUNTRY OF INCORPORATION: Please provide the corporation's state or country of formation. Note: the state or country, must match the state or country of incorporation indicated on the corporation's certifica