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. 
       Name* of Officer / CEO              Address                                                                     City                         State Zip Code 
  
       Name* of Officer / CFO              Address                                                                     City                         State Zip Code 
  
      Name* of 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 $235.00 ($225 filing fee + $10 paper filing service charge) 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 
     
 * Enter individual’s legal name, i.e. first and last name without use of initials or nicknames. Middle names or initials may be included. 
                                                                                                                                                          FORM CD 236 
                                                                                                                                                          (Rev. 10/2019)