Form SS-4 (Rev. January 2009)

Form
SS-4
(Rev. January 2009)
Type or print clearly.
Department of the Treasury
Internal Revenue Service
8a
8c
9a
Application for Employer Identification Number
(For use by employers, corporations, partnerships, trusts, estates, churches,
government agencies, Indian tribal entities, certain individuals, and others.)
©
©
See separate instructions for each line.
Keep a copy for your records.
1
Legal name of entity (or individual) for whom the EIN is being requested
2
Trade name of business (if different from name on line 1)
3
Executor, administrator, trustee, “care of” name
4a
Mailing address (room, apt., suite no. and street, or P.O. box)
5a
Street address (if different) (Do not enter a P.O. box.)
4b
City, state, and ZIP code (if foreign, see instructions)
5b
City, state, and ZIP code (if foreign, see instructions)
6
County and state where principal business is located
7a
Name of principal officer, general partner, grantor, owner, or trustor
Is this application for a limited liability company (LLC) (or
a foreign equivalent)?
Yes
7b
SSN, ITIN, or EIN
8b
If 8a is “Yes,” enter the number of
©
LLC members
No
No
Estate (SSN of decedent)
Partnership
Plan administrator (TIN)
Corporation (enter form number to be filed)
10
Yes
If 8a is “Yes,” was the LLC organized in the United States?
Type of entity (check only one box). Caution. If 8a is “Yes,” see the instructions for the correct box to check.
Sole proprietor (SSN)
9b
OMB No. 1545-0003
EIN
©
Trust (TIN of grantor)
Personal service corporation
National Guard
State/local government
Church or church-controlled organization
Farmers’ cooperative
Federal government/military
Other nonprofit organization (specify) ©
Other (specify) ©
If a corporation, name the state or foreign country
(if applicable) where incorporated
Reason for applying (check only one box)
Started new business (specify type)
State
REMIC
Indian tribal governments/enterprises
Group Exemption Number (GEN) if any ©
Foreign country
Banking purpose (specify purpose)
©
©
Changed type of organization (specify new type)
©
Purchased going business
Hired employees (Check the box and see line 13.)
Created a trust (specify type)
©
11
Compliance with IRS withholding regulations
Created a pension plan (specify type) ©
Other (specify) ©
Date business started or acquired (month, day, year). See instructions.
12 Closing month of accounting year
13
Highest number of employees expected in the next 12 months (enter -0- if none).
14
15
16
Do you expect your employment tax liability to be $1,000
or less in a full calendar year?
Yes
No (If you
Agricultural
Household
Other
expect to pay $4,000 or less in total wages in a full
calendar year, you can mark “Yes.”)
First date wages or annuities were paid (month, day, year). Note. If applicant is a withholding agent, enter date income will first be paid to
©
nonresident alien (month, day, year)
Check one box that best describes the principal activity of your business.
Construction
17
18
Rental & leasing
Transportation & warehousing
Finance & insurance
Health care & social assistance
Accommodation & food service
Wholesale-agent/broker
Retail
Wholesale-other
Real estate
Manufacturing
Other (specify)
Indicate principal line of merchandise sold, specific construction work done, products produced, or services provided.
Has the applicant entity shown on line 1 ever applied for and received an EIN?
If “Yes,” write previous EIN here ©
Yes
No
Complete this section only if you want to authorize the named individual to receive the entity’s EIN and answer questions about the completion of this form.
Third
Party
Designee
Designee’s name
Designee’s telephone number (include area code)
Address and ZIP code
Designee’s fax number (include area code)
(
(
Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, it is true, correct, and complete.
Name and title (type or print clearly)
©
)
)
Applicant’s telephone number (include area code)
(
)
Applicant’s fax number (include area code)
Signature
©
Date
For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.
©
(
Cat. No. 16055N
)
Form
SS-4
(Rev. 1-2009)
Form SS-4 (Rev. 1-2009)
Page
2
Do I Need an EIN?
File Form SS-4 if the applicant entity does not already have an EIN but is required to show an EIN on any return, statement,
or other document.1 See also the separate instructions for each line on Form SS-4.
IF the applicant...
Started a new business
AND...
Hired (or will hire) employees,
including household employees
Does not already have an EIN
Complete lines 1, 2, 4a–6, 7a–b (if applicable), 8a,
8b–c (if applicable), 9a, 9b (if applicable), 10–18.
Opened a bank account
Needs an EIN for banking purposes only
Complete lines 1–5b, 7a–b (if applicable), 8a, 8b–c
(if applicable), 9a, 9b (if applicable), 10, and 18.
Changed type of organization
Either the legal character of the organization or its
ownership changed (for example, you incorporate a
sole proprietorship or form a partnership) 2
Complete lines 1–18 (as applicable).
Does not already have an EIN
The trust is other than a grantor trust or an IRA
trust 4
Complete lines 1–18 (as applicable).
Complete lines 1–18 (as applicable).
Created a pension plan as a
plan administrator 5
Needs an EIN for reporting purposes
Complete lines 1, 3, 4a–5b, 9a, 10, and 18.
Is a foreign person needing an
EIN to comply with IRS
withholding regulations
Needs an EIN to complete a Form W-8 (other than
Form W-8ECI), avoid withholding on portfolio assets,
or claim tax treaty benefits 6
Complete lines 1–5b, 7a–b (SSN or ITIN optional),
8a, 8b–c (if applicable), 9a, 9b (if applicable), 10,
and 18.
Is administering an estate
Needs an EIN to report estate income on Form 1041
Complete lines 1–6, 9a, 10–12, 13–17 (if applicable),
and 18.
Is a withholding agent for
taxes on non-wage income
paid to an alien (i.e.,
individual, corporation, or
partnership, etc.)
Is a state or local agency
Is an agent, broker, fiduciary, manager, tenant, or
spouse who is required to file Form 1042, Annual
Withholding Tax Return for U.S. Source Income of
Foreign Persons
Complete lines 1, 2, 3 (if applicable), 4a–5b, 7a–b (if
applicable), 8a, 8b–c (if applicable), 9a, 9b (if
applicable), 10, and 18.
Serves as a tax reporting agent for public assistance
recipients under Rev. Proc. 80-4, 1980-1 C.B. 581 7
Complete lines 1, 2, 4a–5b, 9a, 10, and 18.
Is a single-member LLC
Needs an EIN to file Form 8832, Classification
Election, for filing employment tax returns and
excise tax returns, or for state reporting purposes 8
Complete lines 1–18 (as applicable).
Is an S corporation
Needs an EIN to file Form 2553, Election by a Small
Business Corporation 9
Complete lines 1–18 (as applicable).
Purchased a going business
Created a trust
Does not currently have (nor expect to have)
employees
3
THEN...
Complete lines 1, 2, 4a–8a, 8b–c (if applicable), 9a,
9b (if applicable), and 10–14 and 16–18.
1
For example, a sole proprietorship or self-employed farmer who establishes a qualified retirement plan, or is required to file excise, employment, alcohol,
tobacco, or firearms returns, must have an EIN. A partnership, corporation, REMIC (real estate mortgage investment conduit), nonprofit organization
(church, club, etc.), or farmers’ cooperative must use an EIN for any tax-related purpose even if the entity does not have employees.
2
However, do not apply for a new EIN if the existing entity only (a) changed its business name, (b) elected on Form 8832 to change the way it is taxed (or is
covered by the default rules), or (c) terminated its partnership status because at least 50% of the total interests in partnership capital and profits were sold or
exchanged within a 12-month period. The EIN of the terminated partnership should continue to be used. See Regulations section 301.6109-1(d)(2)(iii).
Do not use the EIN of the prior business unless you became the “owner” of a corporation by acquiring its stock.
3
4
However, grantor trusts that do not file using Optional Method 1 and IRA trusts that are required to file Form 990-T, Exempt Organization Business Income Tax
Return, must have an EIN. For more information on grantor trusts, see the Instructions for Form 1041.
5
A plan administrator is the person or group of persons specified as the administrator by the instrument under which the plan is operated.
6
Entities applying to be a Qualified Intermediary (QI) need a QI-EIN even if they already have an EIN. See Rev. Proc. 2000-12.
7
See also Household employer on page 4 of the instructions. Note. State or local agencies may need an EIN for other reasons, for example, hired employees.
8
See Disregarded entities on page 4 of the instructions for details on completing Form SS-4 for an LLC.
9
An existing corporation that is electing or revoking S corporation status should use its previously-assigned EIN.
R-16019 (5/08) CR1
Application for Louisiana Revenue Account Number
P.O. Box 201
Baton Rouge, LA 70821-0201
(225) 219-7318
For office use only.
Date of application
1. A. Sales/ Use B.
■ Louisiana General Sales Tax
C.
■ Statewide Hotel/Motel
D.
■ Jefferson Parish Hotel/Motel
E. ■ Orleans Parish Hotel/Motel
■ Orleans Parish Restaurant
■ N.O. Airport Food Establishments
■ Motor Vehicle Lessors/Rentors
■ Withholding F.
■ Vehicle Rental Excise ■ Severance
Oil and Gas Classification ■ Taxpayer Only
■ Producer Only
■ Producer/Taxpayer
■ Other
_________________________
_________________________
_________________________
2. Reason for applying A. ■ Started new business
C. ■ Other (specify)
B. ■ Purchased ongoing business: Name of previous owner
3. Indicate the account number you use for each tax filed with the Louisiana Department of Revenue.
LA Corp. Tax Number None ■
LA Sales Tax Number
None ■
LA Excise Taxes Number
LA Withholding Tax Number None ■
4.
A.
Legal name(s)
B.
Trade name of business 5.
A.
Business location address (NO P.O. Box or General Delivery)
B.
City and state
6.
A.
Address for receiving tax forms and correspondence (If same location, write “same”.)
B.
7.
Type of organization: A. ■ Individual
8.
U.S. NAICS Code 9.
(required) LA Severance Tax Number None ■ LA Natural Resource Number None ■
Telephone (
) ___________________
C. ZIP
C.
City and State
B. ■ Partnership
ZIP
D. (
C. ■ Corporation
)
E. ■ Additional mailing
address(es) attached
Telephone
D. ■ Governmental E. ■ Nonprofit
F.■ Other
Federal Employer None ■
ID Number
10. If sole owner (individual): Name
None ■
SSN
Telephone (
Home address
11. If corporation or partner- Name
ship: name, title, Social
Security Number, home Address
address, and telephone
number of officers or
Name
partners
Title
)
SSN
(
) _________________
Telephone (
) _________________
Telephone Title
SSN
Address
12. A.
Louisiana Charter Number (if known) _________________________
B. State of incorporation (if not Louisiana) ___________________
13. Permits -Sellers of liquor, beer, or wine (wholesale or retail), must obtain a permit from the Office of Alcohol and Tobacco Control. A permit from
the Louisiana State Police Gaming Division must be obtained by sellers of lottery tickets or operators of video poker games. Indicate permit
number(s) that you currently hold.
Lottery Permit Number
B. Expiration Month/Year________________________________
A.
Alcohol Permit Number
Expiration Month/Year________________________________
VPG Permit Number
Expiration Month/Year_ ___________________________
14. A. Corporation Income/Franchise: Date charter filed with Louisiana Secretary of State
Mo. Day Yr.
Domestic B.
Foreign
Fiscal Month
C.
15. Sales or Use Tax: Date business begins sales operations from this location
16. Withholding Tax: (See instructions.) Select filing frequency. ■ quarterly ■ monthly ■ semi-monthly
17. Severance Tax: Select filing frequency. ■ quarterly ■ monthly ■ 45-day
18. Description of business: (required)
Signature of applicant
I affirm that the information given
on this application is true and
Signature of preparer
correct.
Title
Date (mm/dd/yyyy)
1500
For Office Use Only
Account Number
____________________
CITY OF BATON ROUGE
PARISH OF EAST BATON ROUGE
P.O. BOX 2590
BATON ROUGE, LA 70821
PHONE: (225) 389-3084
FAX: (225) 389-5369
Email: [email protected]
Revised 05/28/2008
Louisiana Tax Number
Federal ID Number
Description of Business
NAIC Number
For Office Use Only
Application Number
____________________
(See List of Business Classes)
LEGAL NAME OF BUSINESS
TRADE NAME OF BUSINESS
PHYSICAL LOCATION
(NOT a P.O. Box)
Business Telephone No. (___)_______________
MAILING ADDRESS
APPLICATION FOR:
DATE IN BUSINESS: _____/_____/_____
Sales Tax Registration
Occupational License Tax
Hotel Motel Tax
Insurance Premium Tax
Gross Receipts Tax
Other _________________
REASON FOR APPLYING:
New Business
Purchased Existing Business?
Previous Owner:
Merger
Trade Name of Previous Owner/Business:
Additional Information
Previous Account Number:
Change
Other
BUSINESS LOCATION:
City Limits of Baton Rouge
Unincorporated Parish of EBR
City Limits of Baker
City Limits of Central
City Limits of Zachary
Business Located Outside of EBR
FOR OCCUPATIONAL LICENSE ONLY
FOR OFFICE USE ONLY
Business opened on or prior to June 30 of current year (Minimum Payment)
$50 due
Business opened on or after July 1 of current year (Minimum Payment)
$25 due
Flat Fee Business
$100 / $200 / $250
Hotel / Nursing Home / Rooms
________ (# of rooms) x $2 per room = $
Security Deposit Due?
___Yes ___No
Deposit Due $
If business opened more than 30 days ago:
Tax Due for First Year of Business
Enter Gross Receipts (1st 30 days in business)
$
Less Allowable Deductions (See List below Tax Tables on attached sheet)
$
Tax Basis (Total Gross Receipts less Total Deductions)
$
Multiply Tax Basis by # of months in business (Any month open at least 15 days)
$
Tax Due (Based on Tax Table attached) $
Penalty
$
Interest
$
Total Due
$
*99999999*
ABC Account
Clearance Issued
Contact Phone:
CONTACT PERSON:
Contact Fax:
Contact E-mail:
TYPE OF ORGANIZATION (Ownership) – Please attach a copy of your charter
Individual
Partnership
Corporation
LLC
LLP
IF an Individual:
(Attach valid photo ID)
Owner’s Name
Owner’s Address
IF a Corporation, LLC, LLP,
or Partnership:
(Attach additional names if
necessary)
Owner’s SS#
E-mail Address
Officer / Manager /
Partners Name
Title
Home Address
Non-Profit
Governmental
Other
Telephone Number
Web Site
Agent for Service of Process:
Name
Address
This will affirm that the statements made herein are true and correct to the best of my knowledge:
Signature of Applicant or Owner
Title
Signature of Preparer
Date
Please make checks payable to Parish and City Treasurer
FOR OFFICE USE ONLY
LOCATION/DOMICILE (Circle One)
0001 City of Baton Rouge / EBR Sch Bd
0002 EBR Parish / EBR Sch Bd
0003 City of Baker / Baker Sch Bd
0004 City of Zachary / Zachary Sch Bd
0005 EBR Parish / Zachary Sch Bd
0006 City of Baker / EBR Sch Bd
0007 City of Central / Central Sch Bd
0008 EBR Parish / Central Sch Bd
0009 Outside EBR Parish
0010 Outside Louisiana
GROUP (Circle One)
0000 Not Assigned
0001 Mall of Louisiana
0002 Cortana Mall
0003 Major Chemical & Manuf
0004 Hammond Aire
0005 Downtown Development
CATEGORY (Circle One)
0900 Walk-in Registration
0901 Mail-in Registration
0902 Electronic Registration
0903 Issue to Post
0904 Revenue Inspector
0905 Audit Registration
0906 File Conversion
A
B
D
F
C
E
G
H
FILING FREQUENCY
M Monthy
Q Quarterly
O One Time Sale
X Irregular Filer
L Annual (License Only)
CLASS (Circle One)
0100
Public Utility Only
0101
Public Utility / OLT
0102
Public Utility / STX
0103
Public Utility / STX / OLT
0200
IPT
0201
IPT / STX
0300
HM / Rms
0301
HM / Rms / STX
0302
HM / Rms / STX / OLT
0303
HM / Rms / STX / OLT / ABC
0304
HM
0305
HM / STX
0400
Nursing Home / Rms
0401
Nursing Home / Rms / STX
0500
Amusement Only
0501
Amusement / STX
0502
Amusement / STX / OLT
0503
Amusement / STX / OLT / ABC
0600
STX Only
0601
STX / OLT
0602
STX / OLT / ABC
0700
OLT Only
ACCOUNT TYPE (Circle One)
1520 Retail Mdse/Service/Rental/Etc.
1521 Airline
1522 Travel Agency
1523 Nursing Home
1525 Retail Dealer
1530 Retail Dealers In Motor Fuels
1540 Pawn Broker
1601 Retail Dealer – Institutional Consumers
1610 Wholesale Dealer
1611 Bulk Petro
1612 Wholesale – Motor Vehicle
1622 Building Materials
1710 Finance
1820 Commissioned Services
1822 Real Estate Broker
2010 Investment Banking
2020 Itinerant Vendor (Agricultural & Seafood)
2021 Itinerant Vendor (Parades & Food Vendor)
2022 Promoter
2023 Rolling Vendor
2060 Special Events
2070 Museum for Profit / Transient
2090 Professional
2640 Retail Autos
2710 Contractor
6000 Insurance Company
7001 Public Utilities-Gross Receipts
9999 No Occupational License
Account Set Up By:
Payment Received By:
NAIC
PLEASE CHOOSE A BUSINESS CATEGORY THAT BEST DESCRIBES YOUR BUSINESS ACTIVITY
CATEGORY DESCRIPTION
DETAIL DESCRIPTION
111000
112000
211000
212000
236000
237000
238000
311000
312000
314000
322000
324000
325000
326000
339000
423000
424000
441000
442000
443000
444000
445000
446000
447000
448000
451000
453000
454000
482000
484000
485000
493000
512000
515000
517000
518000
521000
524000
531000
532000
541000
551000
611000
621000
622000
623000
711000
712000
713000
721000
722000
811000
812000
813000
815000
5/28/2008
Agriculture, Forestry, Fishing
Agriculture, Forestry, Fishing
Mining
Mining
Construction
Construction
Construction
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Wholesale Trade
Wholesale Trade
Retail Trade
Retail Trade
Retail Trade
Retail Trade
Retail Trade
Retail Trade
Retail Trade
Retail Trade
Retail Trade
Retail Trade
Retail Trade
Transportation & Warehouse
Transportation & Warehouse
Transportation & Warehouse
Transportation & Warehouse
Information
Information
Information
Information
Finance & Insurance
Finance & Insurance
Finance & Insurance
Finance & Insurance
Professional, Scientific & Technology
Management of Companies
Educational Services
Health Care & Social Assistance
Health Care & Social Assistance
Health Care & Social Assistance
Arts, Entertainment & Recreation
Arts, Entertainment & Recreation
Arts, Entertainment & Recreation
Accommodation & Food Service
Accommodation & Food Service
Other Services
Other Services
Other Services
Other Services
Crop Production
Animal Production
Oil & Gas Production
Mining (Except Oil & Gas)
Construction of Buildings
Heavy & Civil Engineering Construction
Specialty Trade Contractors
Food Manufacturing
Beverage & Tobacco Product Manufacturing
Textile Product Mills
Paper Manufacturing
Petroleum & Coal Products Manufacturing
Chemical Manufacturing
Plastics & Rubber Product Manufacturing
Miscellaneous Manufacturing
Merchant Wholesalers, Durable Goods
Merchant Wholesalers, Nondurable Goods
Motor Vehicle & Parts Dealer
Furniture & Home Furnishing Stores
Electronic & Appliance Stores
Building Material & Garden Equip/Supplies
Food & Beverage
Health & Personal Care Stores
Gasoline Stations
Clothing & Clothing Accessories Stores
Sporting Goods, Hobby, Book/Music Stores
Miscellaneous Store Retailers
Nonstore Retailers
Rail Transportation
Truck Transportation
Transit & Ground Passenger Transportation
Warehousing & Storage
Motion Picture & Sound Recording Industries
Broadcasting (except internet)
Telecommunications, Internet Service Providers
Portals & Data Processing Services
Monetary Authorities
Insurance Carriers & Related Activities
Real Estate
Rental & Leasing Services
Professional, Scientific & Technology
Management of Companies & Enterprises
Educational Services
Ambulatory Health Care Services
Hospitals
Nursing & Residential Care Facilities
Performing Arts, Spectator Sports & Related Industries
Museums, Historical Sites, & Similar Institutions
Amusement, Gambling & Recreation Industries
Accommodation
Food Services & Drinking Places
Repair & Maintenance
Personal & Laundry Services
Religious, Grantmaking, Civic, Professional & Similar Services
Miscellaneous Other Services
Jay Dardenne
ARTICLES OF INCORPORATION
Secretary of State
(R.S. 12:24)
Domestic Business Corporation
Enclose $60.00 filing fee
Make remittance payable to
Secretary of State
Do Not Send Cash
Return to:
Commercial Division
P. O. Box 94125
Baton Rouge, LA 70804-9125
Phone (225) 925-4704
Web Site: www.sos.louisiana.gov
STATE OF ________________________________
PARISH/COUNTY OF _________________________
1. The name of this corporation is:_______________________________________________________________________
2. This corporation is formed for the purpose of : (check one)
( )
Engaging in any lawful activity for which corporations may be formed.
( )
_____________________________________________________________________________
(use for limiting corporate activity)
3. The duration of this corporation is: (may be perpetual) ____________________________________________________
4. The aggregate number of shares which the corporation shall have authority to issue is :___________________________
5. The shares shall consist of one class only and the par value of each share is ____________________________________
(shares may be without par value) per share.
6. The full name and post office address of each incorporator is : ______________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
7. Other provisions: _________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
8. The corporation’s federal tax identification number is: ____________________________________________________
Incorporator(s) Signature:
________________________________________________________
________________________________________________________
________________________________________________________
On this _____ day of ______________________________200__, before me, personally appeared ____________________
____________________________________________, to me known to be the person described in and who executed the
foregoing instrument, and acknowledged that he executed it as his free act and deed.
NOTARY NAME MUST BE TYPED OR PRINTED WITH NOTARY #
Notary Signature
SS399 Rev. 10/06
(See instructions on back)
INSTRUCTIONS
NOTE:
A corporation is a complex form of business structure. This form contains only the
minimum provisions required by law to be set forth in Articles of Incorporation.
Additional provisions may be advisable or necessary, depending on the specific
needs of each corporation. Consideration should be given to the advantages and
disadvantages of incorporating, and the legal and tax consequences. You are
strongly advised to seek legal advice from an attorney and tax and other business
advice from an accountant.
1.
File the Articles of Incorporation, and the Domestic Corporation Initial Report (form
341) which contains an agent affidavit and the requisite $60 filing fee with the
Secretary of State’s office.
2.
The Articles of Incorporation and the Initial Report may be delivered to the Secretary
of State’s office in advance, for filing as of any specified date (and any given time
on such date) within thirty days after the date of delivery. Requests should be made
in writing and must be submitted along with the Articles of Incorporation and the
Initial Report.
3.
The Articles of Incorporation cannot be accepted for filing unless an Initial Report
form (341) is also filed. Upon filing with our office, you will receive a certified copy
of the Articles and a Certificate of Incorporation. Within thirty (30) days after filing
the Articles of Incorporation with the Secretary of State’s office, a multiple original
of the Articles and the Initial Report (or a copy of each certified by the Secretary of
State), and a copy of the Certificate of Incorporation must be filed with the office
of the recorder of mortgages in the parish where the corporation’s registered office
is located.
4.
Please call the Internal Revenue Service at (901) 546-3920 for information to obtain
a corporation’s federal tax identification number prior to incorporation.
5.
If the Articles of Incorporation are filed within five (5) working days (exclusive of legal
holidays) after acknowledgement, the corporate existence shall begin as of the time
of such acknowledgement.
Jay Dardenne
Secretary of State
DOMESTIC BUSINESS CORPORATION INITIAL REPORT
(R.S. 12:25 AND 12:101)
1. The name of this corporation is:
2. The location and municipal address (not a P.O. Box only) of this corporation’s registered office:
3. The full name and municipal address (not a P. O. Box only) of each of this corporation’s registered
agent(s) is/are:
4. The names and municipal address (not a P.O. Box only) of the first directors are:
Incorporator(s) signature(s)
AGENT’S AFFIDAVIT AND ACKNOWLEDGEMENT OF ACCEPTANCE
I hereby acknowledge and accept the appointment of registered agent for and on behalf of the above
named corporation.
Registered agent(s) signature(s):
Sworn to and subscribed before me, the undersigned Notary Public, on this date:
NOTARY NAME MUST BE TYPED OR PRINTED WITH NOTARY #
Notary Signature
SS341 Rev. 10/06
(See instructions on back)
INSTRUCTIONS
1.
An Initial Report must be completed and filed with the Articles of Incorporation
of a Domestic Business Corporation.
2.
If no directors have been selected when the Initial Report and Articles of
Incorporation are filed, a Supplemental Report, setting forth their names
and addresses must be filed in accordance with R.S. 12:25.
3.
The Affidavit of Acknowledgement and Acceptance contained on the bottom
of this form must be signed by each registered agent before a notary public.
NOTE: Upon filing the Articles of Incorporation and Initial Report with
our office, you will receive certified copies of both documents and a Certificate
of Incorporation. Within thirty (30) days after filing with the Secretary of State’s
office, a multiple original of the Articles and the Initial Report (or a copy of each
certified by the Secretary of State), and a copy of the Certificate of Incorporation
must be filed with the office of the recorder of mortgages of the parish where the
corporation’s registered office is located.