Mail to: PO Box 308 Trenton, NJ 08646 STATE OF NEW JERSEY DIVISION OF REVENUE Overnight to: 33 West State St. 5th Floor Trenton, NJ 08608-1214 "FEE REQUIRED" PUBLIC RECORDS FILING FOR NEW BUSINESS ENTITY Fill out all information below INCLUDING INFORMATION FOR ITEM 11, and sign in the space provided. Please note that once filed, this form constitutes your original certificate of incorporation/formation/registration/authority, and the information contained in the filed form is considered public. Refer to the instructions for delivery/return options, filing fees and field-by-field requirements. Remember to remit the appropriate fee amount. Use attachments if more space is required for any field, or if you wish to add articles for the public record. 1. Business Name: 2. Type of Business Entity: ___ ___ ___ (See Instructions for Codes, Page 21, Item 2) 4. Stock (Domestic Corporations only; LLCs and Non-Profit leave blank): 6. State of Formation/Incorporation (Foreign Entities Only): 8. Contact Information: Registered Agent Name: 3. Business Purpose : (See Instructions, Page 22, Item 3) 5. Duration (If Indefinite or Perpetual, leave blank): 7. Date of Formation/Incorporation (Foreign Entities Only): _____________________________________________________________________________ Main Business or Principal Business Address: Registered Office: (Must be a New Jersey street address) Street ____________________________________________________ City __________________________________ Zip _______________ Street _________________________________________________ City _______________________State_________Zip ___________ 9. Management (Domestic Corporations and Limited Partnerships Only) · For-Profit and Professional Corporations list initial Board of Directors, minimum of 1; · Domestic Non-Profits list Board of Trustees, minimum of 3; · Limited Partnerships list all General Partners. Name Street Address City State Zip _______________________________ ___________________________________ ______________________ ________ ________________ _______________________________ ___________________________________ ______________________ ________ ________________ _______________________________ ___________________________________ ______________________ ________ ________________ The signatures below certify that the business entity has complied with all applicable filing requirements pursuant to the laws of the State of New Jersey. 10. Incorporators (Domestic Corporations Only, minimum of 1) Name Street Address City State Zip _______________________________ ___________________________________ ______________________ ________ ________________ _______________________________ ___________________________________ ______________________ ________ ________________ Signature(s) for the Public Record (See instructions for Information on Signature Requirements) Signature Name Title Date ________________________________________ ______________________________ ________________________ ___________________ ________________________________________ ______________________________ ________________________ ___________________ American LegalNet, Inc. www.FormsWorkFlow.com -2 3 Public Records Filing for New Business Entity (continued) 11. Additional Entity - Specific Information A. Domestic Non-Profit Corporations (Title 15A) - For IRS exemption considerations, see instructions. 1a. The corporation shall have members: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If yes, qualification shall be: As set forth in the by-laws or, As set forth herein: Yes No 1b.The rights and limitations of the different classes of members shall be: As set forth in the by-laws or, As set forth herein: 2. The method of electing the trustees shall be: As set forth in the by-laws or, As set forth herein: 3. The method of distribution of assets shall be: As set forth in the by-laws or, As set forth herein: B. Foreign Corporations - Profit, Non-Profit and Foreign Legal Professional (Titles 14A and 15A) Attach a certificate of good standing/existence from the state of incorporation not greater than 30 days old to this form. C. Limited Partnerships (Title 42:2A) 1. Set forth the aggregate amount of cash and a description and statement of the agreed value of other property or services contributed (or to be contributed in the future) by all partners: 2. Do the limited partners have the power to grant the right to become a limited partner to an assignee of any part of their partnership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If yes, list the terms/conditions of that power: Yes No 3. Do the limited partners have the right to receive distributions from a partner which includes a return of all or any part of the partner's contributions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If yes, list the applicable terms: Yes No 4. Do the general partners have the right to make distributions to a partner which includes a return of all or any part of the partner's contributions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If yes, list the applicable terms: Yes No 5. What are the rights of the remaining general partners to continue the business in the event that a general partner withdraws? List below: D. Foreign Limited Partnerships (Title 42:2A) Set forth the aggregate amount of cash and a description and statement of the agreed value of other property or services contributed (or to be contributed in the future) by all partners: - 24 - American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR BUSINESS ENTITY PUBLIC RECORD FILING GENERAL INSTRUCTIONS AND DELIVERY/RETURN OPTIONS 1. Type or machine print all Public Records Filing forms, and submit with the correct FEE amount. (See FEE schedule on page 22). 2. Choose a delivery/return option: a. Regular mail - If you are sending work in via regular mail, use the correct address: New Jersey Department of the Treasury Division of Revenue/Corporate Filing Unit PO Box 308 Trenton, NJ 08646-0308 All processed mail-in work will be returned via regular mail. Providing a self-addressed return envelope will speed processing. Otherwise, on a cover letter, indicate the return address if other than the registered office of the business entity. b. Expedited/Over-the-Counter - If you are expediting a filing (8.5 business hour processing), make sure that you deliver over-thecounter