Instructions for properly completing a Certification Memo 
 
 Only use this form if sending to our office by mail or courier service.  If you wish to pay by Credit Card 
 or ACH DO NOT complete this form.  Please use our Document Upload Service located at 
        https://corp.delaware.gov/document-upload-service-information/ 
 
 Submitter’s Information 
 
 Mark the appropriate priority box.  (additional Expedited Cost) 
                         Fees:         Priority 1 (One hr) -     $1000.00 
                                       Priority 2 (Two hr)  -    $ 500.00 
                                       Priority 3 (Same Day) -  Varies – Please see fee schedule 
                                       Priority 4 (24 hour) -    Varies – Please see fee schedule 
 Submitter’s Information 
 
 Completely fill out your individual or business/firm name and complete address.  The attention line needs to 
 be completed if a business or firm name is listed. Please include a phone number and/or email address in 
 case our office needs to contact you. 
 
 The account number is only to be completed by submitters that have an existing Depository account 
 with the Division of Corporations.  Please ignore this field if you do not have a Depository account. 
 
 Certification Request Information 
 
 Complete the name of the entity and the entity File number.  If you do not have the file number, you 
 may leave it blank. 
 
 Type of Certificate Request 
 
 Please mark the item(s) requested. If you need to specify additional information or instructions, please 
 provide the information in the Comments/Filing Instructions section. 
 
 Method of Return Information 
 
 All documents are returned Regular Mail or you can provide a Fed-X or UPS account number for express 
 mail.  Please mark the appropriate method of return. 
 
 Please contact our office at 302-739-3073 with any questions or for verification of fees. 
 
              Return forms and memos to: 
 
              Delaware Division of Corporations 
              401 Federal Street - Suite 4 
              Dover, DE 19901 

                           State of Delaware - Division of Corporations 
                                        CERTIFICATION SHEET 
 
         Priority 1     Priority 2      Priority 3              Priority 4                       Priority 7 
         (One Hr)       (Two Hr)        (Same Day)              (24 Hour)                       (Reg. Work) 

                                                                                         DO NOT WRITE IN THIS SPACE 
 
  SUBMITTER’S INFORMATION 
  Company/Firm 
  Or Individual’s Name                                                                 
  Attention:                                                                         
  Return Address                                                                     
  City-State-Zip                                                  Country            
  Phone:                                Fax#                                          
  Email Address:                                                                      
  Account Number:                                                                    
 
  CERTIFICATION REQUEST INFORMATION 
  Name of Company/Entity                                                                              
  File Number                                                      
 
         TYPE OF CERTIFICATE REQUEST                                                METHOD OF RETURN 
                                                                             (Fax or E-Mail is not available) 
                                                                             Messenger/Pick up 
       Certified     Plain Copy                                              
 
          All Charter Documents                                              
                                                                             Fed Ex      UPS 
          Restated forward                                                   
          Specific document(s) filed on                                      Acct#                                   
          Annual Report Years                                    
       Short Form Good Standing                                              Regular Mail 
                     (Check if additional language required) 
          Incorporation Date                                                COMMENTS/FILING INSTRUCTIONS 
          Taxes Paid                                                        Check#        Total $ enclosed 
          Annual Reports Filed 
       Long Form Good Standing 
       Certificate in RE___________________ (Type of Cert.) 
 
       Apostille/Gold Seal Country 
 
                                                                                    INSTRUCTIONS 
  If you wish to pay by Credit Card or ACH, please DO NOT                    1.  Visit   http://corp.delaware.gov/cvrmemo.shtml 
  complete this form.  Please submit your request using our new              for complete instructions on how to properly 
  Document Upload Service located at                                         complete this memo 
  https://corp.delaware.gov/document-upload-service-information/             2.    Fully shade in the required Priority Square 
                                                                             using a dark pencil or marker, staying 
                                                                             within the square.
  The system will create the cover memo using the information 
  entered at the time of the upload. 
 
         Delaware Division of Corporations, 401 Federal Street, Ste. 4, Dover, De 19901