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State of Wisconsin FILING FEE $100.00

DEPARTMENT OF FINANCIAL INSTITUTIONS Please check box to request 
Division of Corporate & Consumer Services + $25.00
Optional Expedited Service

APPLICATION FOR
FORM 121
Mandatory CERTIFICATE OF AUTHORITY
FOREIGN NONSTOCK CORPORATION
Sec. 181.1503 Wis. Stats.

1. Name of foreign nonstock corporation:

2. If the name is not distinguishable from a name that another entity has already reserved or registered
with the Department, enter a fictitious name adopted pursuant to s. 181.1506(1), Wis. Stats.:
Note – if entering a fictitious name, complete form 21B and submit it with this application.

3. Incorporated under the laws of (provide the state (other than Wisconsin) or the foreign country of
the corporation’s governing law):

4. Date of incorporation (MM/DD/YYYY) 5. Does the corporation have perpetual existence?

Yes

No, organized for a duration of ______________ years

6. Name of the corporation’s registered agent in Wisconsin

7. Email address of the registered agent

8. Street address of the registered office in Wisconsin

City State Zip/Postal code
WI

9. Street address of the principal office (may be located outside Wisconsin)

City State/Province Country Zip/Postal code

Form Corp121 (Revised May 2024) Use of this form is mandatory. Page 1 of 5

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10. Prior to submitting this application, did the corporation transact business in Wisconsin without
holding a certificate of authority?

 
No Yes If “Yes”, complete supplement on page 5 to determine applicable fee.

11. Principal Officers
Complete the applicable portions of the table below, or attach a schedule labeled “Item 11” with the
names, titles, and usual business or home addresses of each of the corporation’s principal officers.

Title Name Address (either usual business address or home address)

CEO

Pres.

Secy.

Treas.

12. Directors
Complete the applicable portions of the table below, or attach a schedule labeled “Item 12” with the
names, board positions, and usual business or home addresses of each of the corporation’s directors.
If the corporation has no directors, enter “None.”

Title Name Address (either usual business or home address)

Chair

Dir.


13. The corporation is organized without capital stock and has members or

does not have members.

14. Executed on
(Date) (Title)

(Printed name) (Signature)

Form Corp121 (Revised May 2024) Use of this form is mandatory. Page 2 of 5

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Contact Information:

Name

Mailing Address

City State Zip Code

Email Address Phone Number

Important annual report requirements, once your entity is formed on our records. This entity type has an
annual report requirement to file each year, starting the year after your entity was formed. Your annual report
due date is listed in the table below. You may file your annual report online, by visiting www.dfi.wi.gov, below
the State of Wisconsin image, you will see a box labeled “File Annual Report,” click on “File Here” and you
will be directed to file online.

INSTRUCTIONS (Refer to section 181.1503, Wis. Stats., for document content)

Please use BLACK ink. Submit one original to State of WI-Dept. of Financial Institutions, Box 93348,
Milwaukee WI, 53293-0348, together with a check for the filing fee of the amount calculated in the Supplement
or $100.00 (if not required to complete the Supplement), payable to the Department of Financial Institutions. (If
sent by express or priority U.S. mail, please mail to State of WI-Dept. of Financial Institutions, Division of
Corporate and Consumer Services, 4822 Madison Yards Way, 4th Fl., North Tower, Madison WI, 53705.) If
requesting optional expedited service, please check the expedited service box in the upper-right corner of the
first page and include an additional $25.00. Filing fees are non-refundable. This document can be made
available in alternate formats upon request to qualifying individuals with disabilities. Upon filing, the
information in this document becomes public and might be used for purposes other than those for which it was
originally furnished. If you have any questions, please contact the Division of Corporate & Consumer Services
at 608-261-7577 (hearing-impaired may call 711 for TTY) or by email atDFICorporations@dfi.wisconsin.gov .

NOTE: Every application must be accompanied by a current CERTIFICATE OF STATUS
(sometimes called “certificate of existence” or “certificate of good standing”) issued by the Secretary of State
(or other official having custody of corporate records) in the state or country under whose laws the corporation
is incorporated, attesting to the existence and status of the corporation. The certificate must be issued not more
than 60 days prior to the date the document is received in this office, in condition for filing. A certified copy of
the charter documents is not an acceptable substitute.

Item 1. Enter the name of the foreign corporation that is registering with the Department.

Item 2. The name under which the corporation is registered in this state must be distinguishable on the records
of the Department from other entities that are registered with the Department and from any name that has been
reserved or registered with the Department. You can preliminarily check the availability of an entity name using
the Department’s corporate records database, which is publicly available through the Department’s website.

Form Corp121 (Revised May 2024) Use of this form is mandatory. Page 3 of 5

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If the name of the corporation is not distinguishable on the records of the department as provided in s.
181.1506(2), Wis. Stats., complete the separate form 21B and enter the fictitious name under which the entity
will do business in this state. The name must contain the word “corporation,” “incorporated,” “company,” or
“limited” or the abbreviation “corp.”, “inc.”, “co.”, or ltd.”, or a variation of these words or abbreviations of like
import in another language, or that differs only with respect to capitalization of letters or punctuation.

Items 3 & 4. Enter the name of the jurisdiction (either a state other than Wisconsin or a foreign country) under
whose laws the foreign corporation is incorporated, as well as the date of its incorporation.

Item 5. Indicate whether the corporation has perpetual existence or a defined period of duration. If it has a
defined period of duration, state its period of duration.

Items 6 & 7. Enter the name of the corporation’s registered agent in this state and the email address of that
agent. Annual report forms, notices and other official communications are directed to the entity’s registered
agent, so it is important to keep this information current.

Item 8. The entity must have a registered agent located at a registered office in Wisconsin. The registered office
address must be identical to the registered agent’s business office and must be an actual physical location with a
street address, and not solely a P.O. Box, mailbox service, or telephone answering service. Provide the street
number and name, city and ZIP code in Wisconsin.

Item 9. Enter the street address of the entity’s principal office. The entity’s principal office may be located
outside Wisconsin.

Item 10. Indicate whether the foreign corporation has done business in Wisconsin without holding a certificate
of authority prior to filing this foreign registration statement. If the answer is “yes,” complete the Supplement
below. Note that not all commercial activities within the state constitute “doing business in this state” for
purposes of this question. For a list of activities that do not constitute doing business in this state for purposes of
this question, review s. 181.1501, Wis. Stats.

Items 11 & 12. Provide the name, title, and address (either the usual business address or home address) of each
of the corporation’s principal officers and directors.

Item 13. Indicate whether the corporation has members.

Item 14. This document must be executed by a person authorized by the corporation.

Form Corp121 (Revised May 2024) Use of this form is mandatory. Page 4 of 5

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                                  SUPPLEMENT 
                                              
  During what year did the corporation start to transact business in Wisconsin  
  without holding a certificate of authority?                       
 
  1. The corporation must pay the applicable annual report fee for 
  each year following the year it first did business in this state without having 
  a certificate of authority. Annual report fees were $15 per year from 1998  
  through 2021 and $65 per year since 2022. 
    
  Calculate the total annual report fees owed for the years in which the corporation  
  transacted business in Wisconsin without registration, and enter the number below. 
          
                                                                   $                   
                                                                    
  2. The corporation must pay a penalty of $50 for each year or partial year 
  in which the corporation transacted business in this state without a certificate  
  of authority, up to a maximum of $500.      
   
  Provide the total penalty by multiplying the number of years (including 
  partial years) in which the corporation transacted business in this state 
  without a certificate of authority by $50, up to a maximum of $500.                  
          
                                                                   $                   
   
  TOTAL SUPPLEMENTAL FEE (add the two numbers above)                          $         
   
  STANDARD APPLICATION FEE                                                    $ 100     
 
  TOTAL FILING FEE (Supplemental Fee plus Standard Fee)                       $ ___________ 
          
 Form Corp121 (Revised May 2024) Use of this form is mandatory.                        Page 5 of 5

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