Free 50659.PDF - Indiana


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State: Indiana
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RENEWAL OF REGISTRATION OF FOREIGN CORPORATION NAME
State For m 5065 9 ( R/1-03 ) Ap proved by State Board of Accounts, 2001

TODD ROKITA S ECRE TARY O F STATE CORPO RATIONS DIVISIO N 3 02 W. Wa sh ington Stre et, Rm . E018 India napoli s, IN 4 6204 Telep hone: (317) 232 -6576

INSTRUCTIONS: Use 8 1/2" x 11" white paper for attachments. Present original and two copies. Attach Certificate of Existence or document of similar import from state or country of domicile and send to the address in the upper right corner of this form. Please visit our office on the web at www.sos.in.gov.

FILING FEE: $30.00
Indiana Code 23 -1-18-3 A ND 23-1-2 3-3

THIS RENEWAL FORM MAY ONLY BE FILED BETWEEN OCTOBER 1 AND DECEMBER 31.

A. Name of Corpor atio n to be renewed (Name of Corpo ration as it ap pears on the Articles of Incorpo ration, or the A men ded Arti cles of Incorpora tion in clud ing additions requir ed by IC 23- 1-49-6 : In cor porated, Cor poration, Compa ny, Limited, Corp., Co., Ltd. and IC 23 -1.5 -2 -8 i f it is a Pro fessional Corpo rati on, the wo rds Pr ofessiona l Corpo ration or P.C.)

B . State or Country o f In cor poration:

C. Addr ess to which corr esp onden ce can be mailed:

D. Date of Inco rporation :

E . A brief de scription of the nature of the business in which the corpo rati on i s enga ged:

NOTE: Registration is for one calendar year, January 1 through Decemeber 31. Registration must be renewed each year by filing a renewal application between October 1 and December 31 for the following year.

In witness whereof, the undersigned being the _____________________________________________________________________
(Title: Offi cer or Directo r)

of said Corporation executes this Registration of Foreign Corporation Name and verifies, subject to the penalties of perjury, that the statements contained herein are true this __________________________________________________________________ day of ____________________________________ , 20 __________ .

Signa ture

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