APPLICATION TO REGISTER AN ORGANIZATION NAME
TO THE SECRETARY OF THE COMMONWEALTH OF VIRGINIA:
I, __________________________ (name), the _________________________(title of chief officer of the organization) of ______________________________(name of organization to be registered), hereby apply for the registration of the name of this organization, in accordance with Sections 2.2-411 through 2.2-415 of the Code of Virginia. The address of the organization is: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ The telephone number is: (_____)________________
By signing this application, I certify that I am authorized by this organization to submit this application on its behalf, that I am aware of no reason why it should not be granted, that all information provided is complete and correct, that the application is not considered complete without payment of the fee and that the fee is not refundable or transferable under any circumstances. I acknowledge that this registration, if approved, expires on December 31 of this calendar year and must be renewed during the month of December in order for registration to be continued for the next calendar year, and that failure to receive a notice regarding renewal shall not constitute a basis for any relief whatsoever, including any waiver or extension of time to renew. I further acknowledge that this registration may be discontinued prior to its expiration if the Secretary of the Commonwealth finds that this application contains any inaccurate or
misleading information, including the validity of the address and telephone number, unless written notification of a change of address or phone number has been submitted to the Office of the Secretary of the Commonwealth.
_________________________ Signature of Chief Officer
COMMONWEALTH OF VIRGINIA City/County of __________ to wit I _________________________, a notary public for the Commonwealth of Virginia, acknowledge that ___________________________, whose signature appears hereon, personally appeared before me this _____ day of _______________, 20____, and signed this application in my presence.
______________________________ Notary Public
My commission expires: _________
Send completed application to:
Organization Registrar Office of the Secretary of the Commonwealth P. O. Box 2454 Richmond, Virginia 23218