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Application For Reinstatement Following Administrative Dissolution (North Carolina)

This form is an application for reinstatement of a corporation after an administrative dissolution in North Carolina. The form provided here is simply a sample of what the actual Form B-09 looks like.

State of North Carolina
Department of the Secretary of State

CORPORATIONS DIVISION
P. O. BOX 29622
RALEIGH, NC 27626-0622


APPLICATION FOR CERTIFICATE OF AUTHORITY

Pursuant to §55-15-03 of the General Statutes of North Carolina, the undersigned corporation hereby applies for a Certificate of Authority to transact business in the State of North Carolina, and for that purpose submits the following:

1. The name of the corporation is __________________________;

and if the corporate name is unavailable for use in the State of North Carolina, the name the corporation wishes to use is:

_________________________________________

2. The state or country under whose laws the corporation was organized is:

________________________________________.

3. The date of incorporation was ______________ ; its period of duration is:

______________________________________.

4. Principal office information: (Select either a or b.)

a. The corporation has a principal office.

The street address and county of the principal office of the corporation is:

Number and Street _________________________________________

City, State, Zip Code _________________________________________

County___________________________

The mailing address, if different from the street address, of the principal office of the corporation is:

___________________________________________

b. The corporation does not have a principal office.

5. The street address and county of the registered office in the State of North Carolina is:

Number and Street ________________________________________

City, State, Zip Code _________________________________________

County ________________________________

6. The mailing address, if different from the street address, of the registered office in the State of North Carolina is:

___________________________________________

7. The name of the registered agent in the State of North Carolina is:

___________________________________________

8. The names, titles, and usual business addresses of the current officers of the corporation are (attach if necessary):

Name ___________________________________________

Title ___________________________________________

Business Address ___________________________________________

9. Attached is a Certificate of Existence (or document of similar import) duly authenticated by the Secretary of State or other official having custody of corporate records in the state or country of incorporation. The Certificate of Existence must be an original and less than six months old.

10. If the corporation is required to use a fictitious name in order to transact business in this State, a copy of the resolution of its board of directors, certified by its secretary, adopting the fictitious name is attached.

11. This application will be effective upon filing, unless a delayed date and/or time is specified:

This is the ___________ day of _____________________ , 20______

______________________________________
Name of Corporation

_______________________________________
Signature

_______________________________________
Type or Print Name and Title


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INSTRUCTIONS FOR FILLING OUT THIS FORM
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Item 1 Enter the complete name of the corporation exactly as it appears in the records of the appropriate official in the state or country of incorporation. If the name cannot be used in North Carolina, enter the name (including a corporate ending) that it wishes to use in North Carolina.

Item 2 Enter the state or country of incorporation.

Item 3 Enter the date of incorporation and the period of duration.

Item 4 Select item "a" if the corporation has a principal office. Enter the complete street address of the principal office and the county in which it is located. If mail is not delivered to the street address of the principal office or if you prefer to receive mail at a P.O. Box or Drawer, enter the complete mailing address of the principal office. Select item "b" if the corporation does not have a principal office.

Item 5 Enter the complete street address of the corporation's registered office and the county in which it is located.

Item 6 Enter the complete mailing address of the corporation's registered agent, only if mail is not delivered to the street address above or if you prefer to receive mail at a P. O. Box or Drawer.

Item 7 Enter the name of the registered agent. The registered agent must be a North Carolina resident, an existing domestic business corporation, nonprofit corporation or limited liability company, or a foreign business corporation, nonprofit corporation or limited liability company authorized to transact business or conduct affairs in North Carolina.

Item 8 Enter the names, titles, and usual business address of the current officers of the corporation.

Item 9 See Form

Item 10 See Form

Item 11 The document will be effective on the date and at the time of filing, unless a delayed date or an effective time (on the date of filing) is specified. If a delayed effective date is specified without a time, it will be effective at 11:59:59 p.m. A delayed effective date may be specified up to and including the 90th day after the day of filing.

Date and Execution

Enter the date the document was executed.

In the blanks provided enter:

• The name of the corporation as it appears in Item 1

• The signature of the representative of the corporation executing the document (may be the chairman of the board of directors or any officer of the corporation).

• The name and title of the above-signed representative.

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