Initial/Annual List and State Business License

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A brief description of the form or Application to be filled out here.

Contact Information
Name
First Last
Email*
Enter Email Confirm Email
Phone*
NAME OF LIMITED-LIABILITY COMPANY
Entity Number
Filing period (to)
Month
Day
Year
Filing period (from)
Month
Day
Year
Return to:
- Return one file stamped copy. (If filing not accompanied by order instructions, file stamped copy will be sent to registered agent.)
CHECK ONLY IF APPLICABLE AND ENTER EXEMPTION CODE IN BOX BELOW
- Pursuant to NRS Chapter 76, this entity is exempt from the business license fee.
Exemption code:
001 - Governmental Entity - 006 - NRS 680B.020 Insurance Co.
MANAGER OR MANAGING MEMBER
Name Address City State Zip Code
Declaration of Eligibility for State Business License Exemption
Entity Name:
NV Business I.D. Number:
Choose one
- 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.
- 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)
Federal Employer Identification Number (FEIN)
NRS 680B.020 Insurance Company 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
If yes, provide license or certificate of authority number
Customer Order Instructions
Name of Entity:
Return to Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Name:
Phone
Return Delivery:
- Email to:
- Fax to:
- Hold for Pick Up
- Mail to Address Above
- FedEx: Acct #
- Other
Email
Fax
FedEx: Acct #
Other
please explain
Order Description: (include items being ordered and fee breakdown)*
Application Fee
Price:
Please select an additional service that you wish to have processed
- Priority Request / Rush Processing + $75
Total
$650.00
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.
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Name	Address	City	State	Zip Code

Contact Information

Declaration of Eligibility for State Business License Exemption

Customer Order Instructions