Free corp 55a - Missouri

JAMES C. KIRKPATRICK STATE INFORMATION CENTER (573) 751-4936

ROBIN CARNAHAN
SECRETARY OF STATE STATE OF MISSOURI

CORPORATIONS (573) 4153

NONPROFIT CORPORATION APPLICATION FOR CERTIFICATE OF AUTHORITY TO DO BUSINESS IN MISSOURI Before qualifying to do business in Missouri, you may wish to review Section 355.751, which describes exemptions from qualification for foreign corporations engaged in certain activities. If you are exempt, you may still be responsible for filings with other agencies. Enclosed are forms upon which you may apply for a certificate of authority. In completing the form, the following will assist you: 1. You must use our forms. 2. Forms must be accompanied by a current "Certificate of Good Standing/Existence" (within 60 days) from the parent state. This must be an original with original seals and signatures. This certificate can normally be obtained from your Secretary of State or authority which issues corporate charters, for a fee. We do not require copies of Articles of Incorporation. 3. The filing fee is $25.00. (The check should be made payable to Director of Revenue) 4. By law, the corporation must list a registered agent and the agent's address in Missouri. 5. The necessary documents should be sent to Secretary of State, Corporation Division, P.O. Box 778, Jefferson City, MO 65102. For express mailings which require a street address, use 600 West Main, Jefferson City, MO 65101. If you have any questions, please contact us toll-free at (866) 223-6535. Sincerely,

Robin Carnahan Secretary of State

Ltr. 2A 01/05

PO BOX 778 · JEFFERSON CITY, MISSOURI · 65102 www.sos.mo.gov

State of Missouri
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This form is designed to be filled out online for your convenience. Please read the instructions carefully. Complete the necessary information, print, sign and mail.

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Robin Carnahan, Secretary of State
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1. The Corporation's name is and it is organized and existing under the laws of 2. If the corporation's name is unavailable, the name it will use in Missouri is 3. The date of its incorporation was
month/day/year

4. The address of its principal place of business is
Address City/State/Zip

5. The name and physical address of its registered agent and office in the State of Missouri is

Name

6. The names of its officers and directors and their business or home addresses are as follows (attach additional sheets as necessary): Name President Vice President Secretary Treasurer Director Director 7. The specific purpose(s) of its business in Missouri: Address City/State/Zip

Name and address to return filed document: Name: Address: City, State, and Zip Code:
Corp. 55A (05.2009)

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Corporations Division PO Box 778 / 600 W. Main St., Rm. 322 Jefferson City, MO 65102

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Application for Certificate of Authority of a Foreign Nonprofit Corporation
(Submit with filing fee of $25.00)

, and the period of its duration is

Address

City/State/Zip

(Please see next page)

8. Does the corporation have members? Yes

No or mutual benefit Corporation?

9. If incorporated in Missouri would the corporation be a public benefit

10. The effective date of this document is the date it is filed by the Secretary of State of Missouri unless a future date is otherwise indicated:
Date may not be more than 90 days after the filing date in this Office

In Affirmation thereof, the facts stated above are true and correct: (The undersigned understands that false statements made in this filing are subject to the penalties provided under Section 575.040, RSMo)

Authorized signature of officer of chairman of the board

Printed Name

Title

Date

Note: You must submit a current (not more than 60 days old) certificate of good standing or certificate of existence with this application. This may be obtained from the Secretary of State or other authority that issues corporate charters in your state of domicile.

Corp. 55A (05/2009)