Free Application for Certificate of Authority to Transact Business - Nebraska

APPLICATION FOR CERTIFICATE OF AUTHORITY
TO TRANSACT BUSINESS

John A. Gale, Secretary of State

Room 1301 State Capitol, P.O. Box 94608 Lincoln, NE 68509 http://www.sos.state.ne.us Submit in Duplicate
Attach a certificate of good standing duly authenticated by the official having custody of the corporate records in the state or country under whose law the corporation is incorporated. Such certificate shall not be more than 60 days old. A certified copy of the articles of incorporation should not be submitted and is not acceptable in lieu of such certificate.

Name of Corporation_____________________________________________________ Fictitious Name of Corporation_____________________________________________
(to be used only if actual corporate name is unavailable for use or does not comply with Nebraska law)

Incorporated under the laws of______________________________________________ Date Incorporation__________________________, _______
Year

Period of Duration__________________________ Address of Principal Office________________________________________________
Street Address City State Zip

Registered Agent________________________________________________________ Registered Office_____________________________________________NE________
Street Address and Post Office Box (if any) City Zip

DATED________________________

_________________________________
Signature

_________________________________
Printed Name/Title NOTE: The Business Corporation Act requires that every filing be signed by the chairperson of the board of directors, the president, or one of the officers of the corporation. If the corporation has not yet been formed or directors have not yet been selected, the filing shall be signed by an incorporator. If the corporation is in the hands of a receiver, trustee, or other court appointed fiduciary, the filing shall be signed by that fiduciary.

NOTE: To complete this form, you must list officers and directors on back FILING FEE: $145.00 (if you have more than one page listing officers and directors please add $5.00 a page for each additional page)
Revised 12/30/2008 Neb. Rev. Stat. 21-20,170

OFFICERS:
_________________________________________ Name/Title _________________________________________ Street Address _________________________________________ City State Zip _________________________________________ Name/Title _________________________________________ Street Address _________________________________________ City State Zip _________________________________________ Name/Title _________________________________________ Street Address _________________________________________ City State Zip _________________________________________ Name/Title _________________________________________ Street Address _________________________________________ City State Zip _________________________________________ Name/Title _________________________________________ Street Address _________________________________________ City State Zip _________________________________________ Name/Title _________________________________________ Street Address _________________________________________ City State Zip

DIRECTORS:
________________________________________ Name ________________________________________ Street Address ________________________________________ City State Zip ________________________________________ Name ________________________________________ Street Address ________________________________________ City State Zip ________________________________________ Name ________________________________________ Street Address ________________________________________ City State Zip ________________________________________ Name ________________________________________ Street Address ________________________________________ City State Zip ________________________________________ Name ________________________________________ Street Address ________________________________________ City State Zip ________________________________________ Name ________________________________________ Street Address ________________________________________ City State Zip

Please Copy this page and submit additional pages if needed.