Initial List/Annual List and State Business License Application

Contact Information

Name

First Last

Email*

Enter Email Confirm Email

Phone*

Name of Corporation

Entity Number

For the filling period (of)

For the filling period (to)

Return a copy

Return one file stamped copy

Check if applicable

Pursuant to NRS Chapter 76, this entity is exempt from the business license fee.
This corporation is a publicly traded corporation.
This publicly traded corporation is not required to have a Central Index Key number

Exemption Code

Central Index Key number

List of Members

Name of President

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Secretary

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Treasurer

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Director

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Title of Officer or Other Authorized Agent

Declaration of Eligibility for State Business License Exemption

Entity Name

NV Business I.D. Number

Choose one

001 - Governmental Entity - This entity is an incorporated or unincorporated agency or instrumentality of the United States government or any state government; a corporation wholly owned by the United States government; or county, city, district, or other political subdivision of a state.
002 - 501(c) Nonprofit Entity - This entity is qualified as a 501(c) Nonprofit Entity pursuant to Title 26 U.S.C. Section 501(c). Please provide the Internal Revenue Service (IRS) issued Federal Employer Identification Number (FEIN)
006 - NRS 680B.020 Insurance Company

Federal Employer Identification Number (FEIN)

Are the activities of this entity regulated through a license or certificate of authority granted by the Division of Insurance pursuant to NRS Title 57?

Yes
No

Provide license or certificate of authority number

Custom Order Instructions

Processing Service Requested

Regular
24-Hour Expedite
2-Hour Expedite
1-Hour Expedite

Name of Entity

Date

Return to

Street Address Address Line 2 City State ZIP Code

Contact Name

First Last

Phone

Return Delivery

Email to:
Fax to:
Hold for Pick Up
Mail to Address Above
FedEx: Acct #
Other:

Email

Phone

FedEx: Acct #

Other

Order Description

Application Fee

Price:

Please select an additional service that you wish to have processed

Priority Request / Rush Processing + $75

Total

$0.00

Consent

I agree

I CERTIFY THAT THE RECITATIONS CONCERNING THE VESSEL: NAME, TONNAGE, DIMENSIONS, PROPULSION, OWNERSHIP, HAILING PORT, RESTRICTIONS, ENTITLEMENTS, REMARKS AND ENDORSEMENTS CONTAINED IN THE CERTIFICATE OF DOCUMENTATION REMAIN ABSOLUTELY THE SAME.

NAME:*

Type your full name to sign this secure webform

Signature*

CAPACITY OF PERSON SIGNING (E.G., AGENT, TRUSTEE, GENERAL PARTNER, CORPORATE OFFICER, MEMBER)

Authorization*

I agree

I agree to pay the above total amount according to the card issuer agreement and hereby authorize the charge for the total amount above for the processing of selected applications. I understand that my application will be processed in the order in which it is received by Corporation Center, a private fee-for-service company, not owned or operated by any governmental agency. I understand that application and processing fees are non-refundable as per Corporation Center’s no refund policy.

Credit Card

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