File Number ______________________ State of Utah DEPARTMENT OF COMMERCE Division of Corporations & Commercial Code Application for Authority to Conduct Affairs for a Foreign Corporation Non-Refundable Processing Fee: [ ] Profit $52.00 [ ] Nonprofit $22.00 A certification of Good Standing/Existence from the State of Incorporation dated no earlier than ninety (90) days prior to filing with this office is attached to this application. 1. Exact Corporate Name: 2. A corporation of the state of: 3. Date Incorporated: 4. The corporation’s period of duration is: 5. The address of the corporation's principal office is: (usually perpetual) _________________________________________________ Street Address Line 1 _________________________________________________ Street Address Line 2 City State Zip 6. The Registered Agent in Utah is: 7. The address of the registered office in Utah is: Utah Street Address Required, PO Boxes can be listed after the Street Address _________________________________________________ Street Address Line 1 _________________________________________________ Street Address Line 2 City State UT Zip 8. I, ____________________________, agree to serve as a registered agent for the above-mentioned foreign corporation. _____________________________________________________ Signature of Registered Agent (Required). 9. If the name is not available in Utah the corporation shall use as it’s name: {Please refer to (U.C.A. 16-10a-1506)} 10. The corporation commenced or intends to commence business in Utah on: 11. The names and addresses of the corporation's officers and directors are: Position: President Name Address City State Zip Vice-President Secretary Treasurer Director Director Director Other 12. The business purposes to be pursued in Utah are: Under penalties of perjury, I declare that this application for Certificate of Authority has been examined by me and is, to the best of my knowledge and belief, true, correct and complete. ______________________________________ ____________________________________ Authorized Signer Signature Title Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity. Mailing/Faxing Information: www.corporations.utah.gov/contactus.html Division's Website: www.corporations.utah.gov American LegalNet, Inc. www.FormsWorkflow.com