Wyoming Non Profit Foreign Corporation Certificate of Authority Form

In order to create and register a non-profit, foreign corporation in Wyoming, the following form must be used. Send the form plus a $25 filing fee.Download

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For Office Use Only  	
 	Wyoming Secretary of State 	
  State Capitol Building, Room 110 
   200 West 24	th Street  
  Cheyenne, W Y 82002-0020 
  Ph.  307. 777.7311  
  Fax 307.777.5339  
  Email:  Business@wy o.gov  	
 	
FNP -CertificateAuthority  – Revised  11/2012	    	 	
 	
Foreign  Nonprofit Corporation  
Application for Certificate of Authority  	
 
Pursuant to W.S. 17-19-1503 of the Wyoming Nonprofit  Corporation Act, the undersigned corporation hereby applies 
for a Certificate of Authority to transact business in the state of Wy oming, and for that purpose submits the following 
statement: 
 
1. Name of the Nonprofit Corporation as incorporated:  
 
 
 
2.  Incorporated  under the laws of:  	
(State or country of incorpor ation) 	
 
3. Date of incorporat ion: 	
            (mm/dd/yyyy)  	
 
4. Period of duration:  
(This is referring to the length of time the nonprofit  corporation intends to exist and not the length of time it has been in existence. The most 
common term used is “perpetual.” You may refer to your Articles of Incorporation or contact the C orporations  Division in your state of 
incorporation for your period of duration.)  
 
5. Mailing address of the nonprofit corporation:  
 
 
 
 
 
6. P rincipal office  address: 
 
 
 
 
 
7. N ame and physical address of its registered agent: 
(The registered agent may be an individual resident in Wyoming, a domestic or foreign entity  authorized to transact business in  Wyoming, 
having a business office identical with such registered office. The registered agent must have a physical address in Wyoming.  A Post Office 
Box or Drop Box is not acceptable. If the registered office includes a suite number, it must be included in the registered office address .)

FNP-CertificateAuthority  – Revised  11/2012 
8. Names and usual business  addresses of its current officers and directors:  
 
Office	     Name	     Address	 	
 
President  
 
 
Vice President  
 
 
Secretary 
 
 
Treasurer  
 
 
Director 
 
 
Director   
 
 
Director 
 
 
 
 
9. Does this corporation have members?   Yes    No 
 
10.  If this corporation had been incorporated under the laws of this state, would it be  	
(Check appropriate choice.)	: 	
 
   a. Public benefit corporation  
   b. M utual benefit corporation 
   c. R eligious corporation   
 
11. The corporation accepts the constitution of the state of Wyoming in compliance  with the requirement of   
A rticle 10, S ection 5 of the Wyoming C onstitution. 
 
12. For name avail ability purposes list the type of business the nonprofit corporation will be conducting:  
 
 
 
 
 
Signature: ___________________________________________   Date: 
(May be executed by Chairman of Board, President or another of its officers .)      (mm/dd/yyyy)  
 
Print Name:       Contact Person:  
 
Title:        Daytime Phone Number:  
 
Email:

FNP-CertificateAuthority  – Revised  11/2012 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Other Requirements:  
•  An annual report will be due annually on the first day of the anniversary month of formation. If not paid 
within sixty (60) days from  the due date, the entity will be subject to dissolution/revocation.  
 
Checklist	 	
          Filing Fee: $25.00   Make check or money order payable to Wyoming Secretary of State.  
          The completed a pplication must be accompanied by an original certificate of existence/good standing ,  
          dated not more than sixty (60) days prior to filing in Wyoming	, duly authenticated by the Secretary of State       	 	
          or other official having custody of corporate records in the state or country of formation.  
          The A pplication m ust be accompanied by a  written consent to appointment executed by the registered agent.  
          For consistency the Secretary of State’s Office will only keep one version of the agent’s name on file.  
          Please submit one originally signed  document and one exact photocopy of the filing.  
          Please review form prior to submitting to the Secretary of State to ensure all areas have been  
          completed to avoid a delay in the  processing of your documents.

Wyoming Secretary of State 	
 State Capitol Building, Room 110 
   200 West 24	th Street  
  Cheyenne, W Y 82002-0020 
  Ph. 307.777.7311 
  Fax 307.777.5339 
  Email: Business@ wyo.gov	
 	
RAConsent  – Revised  12/11 	
 
Consent to Appointment  by Registered Agent  
 	
 
 
I,                                                                                                              \
                    , registered office located at   
    (name of registered agent)  
       
              voluntarily consent to serve   
 
                               
       	
*  (registered office  physical address, city, state & zip)  	
 
as the  registered agent for                                                                            \
                                                             	                                                            	 	
                                                              (nam e of business entity)  
 
I hereby certify that I am in compliance with the requirements of W.S. 17- 28-101 through W.S. 17- 28-111.   
 
 
Signature:__________________________________________   Date: 
                                       ( Shall be executed by  the registered agent .)                      (mm/dd/yyyy)  
 
Print Name:       Daytime Phone : 
 
Title:        Email: 
 
Registered Agent  Mailing Address 
 (if different than above) :	
 	
 
 
*If this is a new address,  complete the following: 
 
Previous Registered Office (s):  
I  hereby  certify that:  
•   After the changes are made, the street address of  my registered office and business office will be identical.  
•   This change affects every entity served by  me and  I have notified each entity of the registered office change.  
•   I certify t hat the above information is correct and I am in compliance with the requirements of W.S. 17 -28- 101 through   
W.S. 17 -28- 111.   
 
 
Signature:  __________________________________________   Date: 
                                       ( Shall be executed by  the registered agent .)                    (mm/dd/yyyy)   
 Checklist	 	
          Submit o ne originally signed  consent to appointment  and one exact photocopy.