Free SS-4431.indd - Tennessee

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Corporate Filings 312 Rosa L. Parks Avenue 6th Floor, William R. Snodgrass Tower Nashville, TN 37243

APPLICATION FOR CERTIFICATE OF AUTHORITY (FOR PROFIT)

Pursuant to the provisions of Section 48-25-103 of the Tennessee Business Corporation Act, the undersigned corporation hereby applies for a certificate of authority to transact business in the State of Tennessee, and for that purpose sets forth: 1. The name of the corporation is *If different, the name under which the certificate of authority is to be obtained is
[NOTES: The Secretary of State of the State of Tennessee may not issue a certificate of authority to a foreign corporation for profit if its name does not comply with the requirements of Section 48-14-101 of the Tennessee Business Corporation Act. *If obtaining a certificate of authority under a different corporate name, an application for registration of an assumed corporate name must be filed pursuant to Section 48-14-101(d) with an additional $20.00 fee.]

2. The state or country under whose law it is incorporated is 3. The date of its incorporation is duration, if other than perpetual, is (must be month, day, and year), and the period of .

4. The complete street address (including zip code) of its principal office is
Street City State/County

5. The complete street address (including the county and the zip code) of its registered office in Tennessee and the name of its registered agent is
Street City State/County

Registered Agent 6. The names and complete business addresses (including zip code) of its current officers are: (Attach separate sheet if necessary.)

7. The names and complete business addresses (including zip code) of its current board of directors are: (Attach separate sheet if necessary.)

8. If the corporation commenced doing business in Tennessee prior to the approval of this application, the date of commencement (month, day and year) . NOTE: Additional filing fees may apply. See Section 48-25-102(d). 9. The corporation is a corporation for profit. 10. If the document is not to be effective upon filing by the Secretary of State, the delayed effective date/time is (date), (time). ,
[NOTE: A delayed effective date shall not be later than the 90th day after the date this document is filed by the Secretary of State.] [NOTE: This application must be accompanied by a certificate of existence (or a document of similar import) duly authenticated by the Secretary of State or other official having custody of corporate records in the state or country under whose law it is incorporated. The certificate shall not bear a date of more than two (2) months prior to the date the application is filed in this state.]

Signature Date Signer's Capacity

Name of Corporation Signature Name (typed or printed)

SS-4431 (Rev. 2/08)

Filing Fee: $600