Free Sec - Wisconsin


File Size: 107.1 kB
Pages: 4
Date: February 28, 2003
File Format: PDF
State: Wisconsin
Category: Secretary of State
Author: Robert Ritger
Word Count: 946 Words, 6,165 Characters
Page Size: Letter (8 1/2" x 11")
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http://www.wdfi.org/_resources/indexed/site/corporations/form121.pdf

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Sec. 181.1503 Wis. Stats.

State of Wisconsin DEPARTMENT OF FINANCIAL INSTITUTIONS Division of Corporate & Consumer Services

FOREIGN NONSTOCK CORPORATION ­ CERTIFICATE OF AUTHORITY APPLICATION
1. ! ORIGINAL certificate Name of corporation 2. State or Country of Incorporation

A OR
1. (Indicate (X) if the application is for an ORIGINAL or an AMENDED certificate. 2. State or Country of Incorporation

! AMENDED certificate

(If changed, enter the new corporate name or new state or country of incorporation. Also, set forth in section A above, the name under which the corporation is presently licensed in Wisconsin, and complete all other items, except item 8. Name of corporation

B
3. Address of Principal Office 4. Date of Incorporation 5. Period of Duration Perpetual ! yes ! no

6. Name of Registered Agent in Wisconsin

7. Street Address of Registered Office in Wisconsin

DFI/CORP/121(R02/10/03) Use of this form is mandatory.

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8. Has the corporation transacted business in Wisconsin after December 31, 1998 without holding a Certificate of Authority?

! No

! Yes

If "Yes", complete supplement on page 4.

9. Names and Usual Business Addresses of Officers (may be scheduled) Title CEO. Pres. V-P Secy Treas. 10. Names and Usual Business Addresses of Directors (may be scheduled) Title Chair. Dir. Dir. Dir. Select and remit the appropriate FILING FEE from one of the columns below: ORIGINAL AMENDED ORIGINAL The corporation is organized without capital stock Certificate Certificate Certificate and under Suppl. 12. 11. Complete the following statement by marking (X) in the appropriate area Name Address Name Address

! has members. ! does not have members.

$ 45.00

$ From Suppl. on page 4

$ 30.00

DFI/CORP/121 (R02/10/03)

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13. (Signator's printed name) Executed on (Date) (Officer's title) NOTE: Every application must be accompanied by a current CERTIFICATE OF STATUS. INSTRUCTIONS (Ref. sec. 181.1503 or 181.1504, Wis. Stats. for document content) Submit one original and one exact copy to Department of Financial Institutions, P O Box 7846, Madison WI, 53707-7846, together with the appropriate FILING FEE and a current CERTIFICATE OF STATUS. Filing fee is non-refundable. (If sent by Express or Priority U.S. mail, address to 345 W. Washington Ave., 3rd Floor, Madison WI, 53703). Sign the document manually or otherwise as allowed under sec. 181.0103 (23). NOTICE: This form may be used to accomplish a filing required or permitted by statute to be made with the department. Information requested may be used for secondary purposes. If you have any questions, please contact the Division of Corporate & Consumer Services at 608-261-7577. Hearing-impaired may call 608-266-8818 for TTY. This document can be made available in alternate formats upon request to qualifying individuals with disabilities. This application is appropriate for use by a foreign non-stock corporation, including a non-profit corporation. Foreign business corporations apply on Form 21 (Foreign Business Corporation ­ Certificate of Authority Application). 1 & 2 A For an ORIGINAL certificate of authority, complete items A 1 and A 2 and items 3 thru 13. If the corporation has transacted business in Wisconsin without holding a certificate of authority, also complete supplement on page 4. Respond to all items. 1 & 2 B. For an AMENDED certificate of authority, complete items B 1 and B 2, 3 through 7, and 9 through 13. Respond to all items. Supplement is not required. The certificate of status must be issued under the new name of the corporation. A certified copy of the charter documents is not an acceptable substitute. 2, 3 & 4. Enter the state or country under whose laws the corporation is organized, the address of the corporation's principal office, and the date of incorporation. 5. Enter the corporation's period of duration, if not perpetual. If the corporation has perpetual existence, so indicate. 6 & 7. The corporation must continuously maintain a registered agent and registered office within Wisconsin. The requirement is statutory. Failure to maintain an agent and office may set grounds for revocation of the corporation's certificate of authority. Annual report forms, notices and other official communications are directed to the corporation's registered agent, so it is important to keep this information current. Request Form 13 (Registered Agent and/or Registered Office Change) to make a change of registered agent or registered office. DFI/CORP/121I(R02/10/03) 3 of 4 (Officer's signature)

FOREIGN NONSTOCK CORPORATION ­

CERTIFICATE OF AUTHORITY APPLICATION


Your return address and phone number during the day: ( INSTRUCTIONS (Continued)

)

-

8. Indicate if the corporation has, or has not, transacted business in Wisconsin after December 31, 1998 without holding a certificate of authority. 9 & 10. Provide the name and address of each of the corporation's officers and directors. 11. Indicate if the corporation has members or does not have members. 12. Determine the filing fee appropriate to an application for an original certificate, an original certificate under the Supplement, or for an amended certificate. 13. The application is to be executed by an officer of the corporation. Print or type the name and title of the officer signing the application and the date it was signed. Every application must be accompanied by a current CERTIFICATE OF STATUS, issued by the Secretary of State (or other official having custody of corporate records), under whose laws it is incorporated, attesting to the existence and status of the corporation. The certificate must be issued not more than 60 days prior to the delivery of this application.

SUPPLEMENT Basic qualification fee PLUS back annual report fees (Each calendar year X $15) $ $ 45.00

PLUS a penalty of $50 for each year or portion of a year, after December 31, 1998, during which the corporation transacted business without a certificate of authority, but not more than $500 $ TOTAL FILING FEE (post to item 12) $

* Annual report and penalty fees apply to applications made on and after January 1, 2000 DFI/CORP/121I(R02/10/03) 4 of 4