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 $70.00                                                       [   ]  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 the name 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         T itle :  
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

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