OFFICE OF SECRETARY OF STATE 
                                                           CORPORATIONS DIVISION 
                                                           2 Martin Luther King Jr. Dr. SE 
                                                                 Suite 313 West Tower 
                                                                 Atlanta, Georgia 30334 
                                                                 (404) 656-2817 
                                                           sos.georgia.gov/corporations                        
    Secretary of State 
                                  APPLICATION FOR CERTIFICATE OF AUTHORITY FOR 
                                          FOREIGN PROFIT OR NONPROFIT CORPORATION 

                  IMPORTANT: Please provide the entity’s primary email address when                                  completing this form. 
Primary Email Address:  

                           NOTICE TO APPLICANT: PRINT PLAINLY OR TYPE REMAINDER OF THIS FORM 
1. 
   Name of Corporation                                                                                                    Name Reservation Number (Optional) 
   Date business commenced (or proposed to commence) in Georgia: 
    (NOTE: (1) Profit Corporations: If the date provided here is more than 30 days prior to the effective date of this application, a $500 penalty must be paid. Penalty is statutory 
    and cannot be waived by Secretary of State. (2) Nonprofit Corporations: There is no late filing penalty.) 
2. 
    Name of Filing Person  

    Address                                                                                 City                                 State                 Zip Code 

    Filer’s Email Address                                                                                            Telephone Number 

3. 
    Principal Office Mailing Address (may be P.O. Box)                                      City                                 State                 Zip Code 
4. 
    Name of Registered Agent in Georgia                                                                              Registered Agent’s Email Address 

    Registered Office Street Address in Georgia (post office box or mail drop not acceptable for registered office address) 
                                                                                                                                GA 
    City                                                         County                                                         State                  Zip Code 
5. 
    Corporation’s Name in State or Country of Incorporation (Must match name on certificate of existence) 
   Check ONE:                                              Jurisdiction (Home State or Country):                          Date of Incorporation in Home Jurisdiction: 
                  PROFIT          NONPROFIT 

6. 
    Officer / CEO                         Address                                                                    City                  State       Zip Code 

    Officer / CFO                         Address                                                                    City                  State       Zip Code 

    Officer / Secretary                   Address                                                                    City                  State       Zip Code 

7. Effective Date: (Choose one)   Upon filing          Delayed effective date and/or time: 
                                                       (A delayed effective date must be within 90 days of the filing date.) 
8. NOTICE:  Mail the following items to the Secretary of State at the above address.
    (1)  This application; 
    (2)  An ORIGINAL certificate of existence or good standing, not more than 90 days old, certified by the home state or country. (Certificate from home 
    state may not be more than 90 days old; copy of articles of incorporation from home state should NOT be submitted.); and 
    (3)  Filing fee of $225.00 payable to “Secretary of State.”  Filing fees are non-refundable. 
    (4)  If applicable, a copy of the resolution of the board of directors, certified by corporation’s secretary, adopting a fictitious or trade name. 

   Signature of Authorized Person                                                                              Date 

   Print name                                                                                                  Title 
                                                                                                                                                       FORM 236 
                                                                                                                                                       (Rev. 10/2018)