Last Revised: 06/2019Page 1 of 3Form 500 Toll Free: 877.767.3453 | Central Ohio: 614.466.3910 OhioSoS.gov | business@OhioSoS.gov File online or for more information: OhioBusinessCentral.gov Certificate Request (See Instructions for Fee Information) Form Must Be Typed Certificate Request Information Submitter's Information Individual/Business Name Mailing Address City Phone Number State ZIP Code Entity Name Charter/License/Registration Number (Choose one by checking box below) Date Filed No Record Certificate Conversion Certificate Qualification Certificate (LLP only) Consolidation Certificate Merger Certificate Full Force and Effect Certificate Good Standing Certificate Date Filed Date Filed Date Filed Number of Certificates Requested: E-mail Address Attention (if applicable) Pick up at Client Service Center Return by MailForm 500 Prescribed by: For screen readers, follow instructions located at this path. American LegalNet, Inc. www.FormsWorkFlow.com Last Revised: 06/2019Page 2 of 3Form 500$5.00 fee for Good Standing, Full Force and Effect, No Record, and Qualification Certificates. $25.00 fee for Merger, Consolidation and Conversion.FeesIndicate the number of certificates requested and check the appropriate box indicating the type(s) of certificate(s) needed. If necessary please provide the date of filing under the name of the certificate being requestedCertificatesPlease provide the name of the entity and its charter/license/registration number. Also, indicate whether the submitter will pick up the documents in our Client Service Center at 180 E. Broad St., Columbus, Ohio 43215 or if the documents should be mailed to the submitter's address provided on the form. If you do not select either box, our office will mail the records to the address provided.Request InformationPlease provide the name of the person or business entity requesting the certificate. Also, provide the submitter's address and a telephone number for us to contact the submitter if we have questions regarding the request.Submitters InformationThis form must be used to file a request for a certificate. The secretary will authenticate records by providing certificates for specific types of filings.Instructions for Certificate RequestIf the information you wish to provide for the record does not fit on the form, please attach additional provisions on a single-sided, 8 275 x 11 sheet(s) of paper.Additional ProvisionsOur office cannot file or record a document which contains a Social Security number or tax identification number. Please do not enter a Social Security number or tax identification number, in any format, on this form.Note American LegalNet, Inc. www.FormsWorkFlow.com Last Revised: 06/2019Page 3 of 3Form 500Types of CertificatesGood Standing Certificate:Certificate applies to Domestic and Foreign corporations. The corporation must be active on our records and in compliance with all filing requirements.Certificate applies to Limited Liability Companies, Limited Partnerships, Limited Liability Partnerships, Trade Names, Fictitious Names, Business Trust, Real Estate Investment Trust and Trademark/Service Marks. The entity must be active on our records and in compliance with all filing requirements.Full Force and Effect Certificate:Certificate recites the particulars of a specific merger filed with the Ohio Secretary of State's Office.Merger Certificate:Certificate states the information related to a specific consolidation filed with the Ohio Secretary of State.Consolidation Certificate:Certificate states a specific name is not on record as an active, inactive, or canceled trade name/fictitious name or business entity.No Record Certificate:Certificate states conversion information for entities converting within the records, off the records and into the records of the Ohio Secretary of State.Conversion Certificate:Certificate states the qualification information for an entity qualifying on the records of the Ohio Secretary of State to become a limited liability partnership.Qualification Certificate: American LegalNet, Inc. www.FormsWorkFlow.com