Instructions for properly completing a Certification Memo 
 
 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. 
 
 Credit Card Information 
 
 All credit card information must be completed.  If the credit card information is not the same as it is listed 
 with the submitter’s information, then please specify the correct information in the comments/filings 
 instruction area on the bottom right hand side of the memo.  You must also include your 3-4 digit security 
 code on the back of the card. 
 
 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 
         CREDIT/DEBIT CARD INFORMATION                                    1.  Visit   http://corp.delaware.gov/cvrmemo.shtml 
         (Visa, MasterCard, American Express or Discover Card Only)             for complete instructions on how to properly 
                                                                                complete this memo 
         CC#             -              -              -                  2.    Fully shade in the required Priority Square 
                                                                                using a dark pencil or marker, staying 
                                                                                within the square. 
         ExpirationDate-                 /                
 
         SecurityCode                      
 
         Delaware Division of Corporations, 401 Federal Street, Ste. 4, Dover, De 19901