Application for Certificate of Authority
(Foreign profit, nonprofit, bank or general business trust T.11A)
Vermont Secretary of State,
128 State Street Montpelier, VT 05633-1104
802-828-2386 CORPORATE NAME Pres Printed Name Title Signature ________________________________________________________Date: NOTE: $100. fee and a certificate of good standing,
dated within 30 days of filing, must be attached to application.
Created and existing under the laws of: :
Date of Incorporation: Profit corporation Non-profit corporation
General purpose:
Principal
Office Address:
City State Zip Code
NAME OF
REGISTERED AGENT:
Registered office address:
City VERMONT Zip Code
The Fiscal month:
Note: December will be designated unless stated
differently.
Annual reports are filed online 2 1/2 months after the close of the fiscal year.
FOREIGN BANK AUTHORITY. Name
of deceased individual:
NAME and ADDRESS of current officers and directors:
V.P.
Sec.
Trea
Dir.
Dir.
Dir.
The person submitting this
form should enter his or her name and title and sign:
File in duplicate with self-addressed envelope. Filing is effective
upon acceptance.