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State of Utah This form cannot be hand written. Print Form
Department of Commerce
Division of Corporations & Commercial Code Clear Form
Application for Authority to Conduct Affairs for a Foreign Corporation
Link to Guide Sheet
A certification of Good Standing/Existence from the State of Incorporation dated no earlier than ninety (90) days prior to filing with this office is
attached to this application.
Non-Refundable Processing Fee: [ ] Profit $54.00 [ ] Nonprofit $30.00
1. Exact Corporate Name:
2. A corporation of the state of: 3. Date Incorporated:
4. The corporation’s period of duration is: (usually perpetual)
5. The address of the corporation's principal ___________________________________________________
office is: Street Address Line 1
___________________________________________________
Street Address Line 2
City State Zip
6. Who/What is thename of theRegistered Agent (Individual or Business Entity or Commercial Registered Agent)?:
____________________________________________________________________________________________
What is a commercial registered agent?
The address must be listed if you have a non-commercial registered agent. See instructions for further details.
Address of the Registered Agent: ______________________________________________________________
Utah Street Address Required, PO Boxes can be listed after the Street Address
City: State UT Zip:
7. If the name is not available in Utah the corporation shall use as it’s name: {Please refer to (U.C.A. 16-10a-1506)}
8. The corporation commenced or intends to commence business in Utah on:
9. The names and addresses of the corporation's officers and directors are:
Position: Name Address City State Zip
President
Vice-President
Secretary
Treasurer
Director
Director
Director
Other
10. The business purposes to be pursued in Utah are:
Under penalties of perjury, I declare that this application for Certificate of Authority has been examined by me and is, to the best of my
knowledge and belief, true, correct and complete.
Authorized Signer Signature: A corporate officer/director must sign here after the form is printed Title:
Optional Inclusion of Ownership Information: This information is not required.
Is this a female owned business? Yes No
Is this a minority owned business? Yes No If yes, please specify: Select/Type the race of the owner here
Under GRAMA {63G-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you
may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity.
Mailing/Faxing Information: www.corporations.utah.gov/contactus.html Division's Website:www.corporations.utah.gov
06/22