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          State of Rhode Island                                                                                                                                                                                                                      This legal document 
          Department of State - Business Services Division                                                                                                                                                                                           should be typed.
                                                                                                                                                                                                                                                     All illegible 
                                                                                                                                                                                                                                                     documents 
Instructions for Filing                                                                                                                                                                                                                              will be REJECTED.
Application for Certificate of Authority for a Non-Profit Corporation
Section 7-6-74 of the General Laws of Rhode Island, 1956, as amended
The attached form is designed to meet minimal statutory filing requirements pursuant to the relevant statutory provision.  
This form and the information provided are not substitutes for the advice and services of an attorney and/or tax specialist.

All filings are public records under RIGL 38-2-1, et seq. This means all information is available to the public by a variety of methods 
including, without limitations, inspections at our office, telephone inquiries and electronically through our online database.

How to complete the form:                                                                                                                                                                                      How to pay the filing fee:
1.  State the name of the corporation. It must match the                                                                                                                                                       The filing fee is payable either by mail via check made 
   name on your Certificate of Good Standing/Letter of                                                                                                                                                         payable to RI Department of State or in person via cash, 
   Status from the state or country of formation ,which must                                                                                                                                                   credit card, or check at the Business Services Division, 148 
   be attached to this form.                                                                                                                                                                                   W. River Street, Ste. 1, Providence, RI 02904. Contact our 
1a. Your entity name must be distinguishable from any name                                                                                                                                                     office at (401) 222-3040 for further information. 
      on file in this office. You may check name availability on                                                                                                                                               
      our website; however, this does not ensure the name                                                                                                                                                      How to confirm your filing:
      will still be available upon filing. If the name is unavailable                                                                                                                                      
                                                                                                                                                                                                               Entity records are retrievable and viewable through our 
      for use in Rhode Island, list an elected name and                                                                                                                                              
                                                                                                                                                                                                               website. Successful filings will NOT result in a mailed 
      complete a Fictitious Business Name Statement, Form                                                                                                                                             
                                                                                                                                                                                                               confirmation. Filings that cannot be processed will be posted 
      626, to be submitted with this application. The Fictitious                                                                                                                                       
                                                                                                                                                                                                               online and then returned. To confirm your submission and 
      Business Name Statement has a $20 filing fee. 
                                                                                                                                                                                                               obtain evidence of your filing:
2.  State the state or country under whose laws the 
   corporation was incorporated.                                                                                                                                                                                  • Go to our Corporate Database.
                                                                                                                                                                                                                  • Enter the name or ID number of your entity and click 
3.  State the date of incorporation in the state of formation. 
                                                                                                                                                                                                                    “Search.”
   Check the appropriate box for the duration of the 
   corporation. Check “date certain for dissolution” only                                                                                                                                                         • Click on the link to your entity record, scroll down, 
   if there is a designated dissolution date in the state or                                                                                                                                                        select “All Filings” and then “View Filing.”
   country of formation, otherwise check “perpetual,” if                                                                                                                                                          • Identify the desired type of filing and click on “PDF” 
   applicable.                                                                                                                                                                                                      under “View PDF” to view and print the record.
4.  List the principal place of business for the 
   corporation.                                                                                                                                                                                                How to maintain your status:
5.  State the name of the registered agent. The registered                                                                                                                                                     The entity is responsible for filing an annual report each 
   agent is an individual or entity that will accept all legal                                                                                                                                                 calendar year, excluding the year of incorporation, between 
   service for this entity. The agent must be a Rhode Island                                                                                                                                                   February 1 and May 1. A courtesy reminder will be mailed 
   resident or entity qualified to do business in this state.                                                                                                                                                  to the registered agent prior to February 1 of each year. Be 
   A Rhode Island street address is required, NOT a P.O.                                                                                                                                                       sure to follow up with your registered agent concerning the 
   Box. In addition to all legal service of process, other                                                                                                                                                     filing of this report. Failure to file an annual report or maintain 
   important correspondence from the state will be sent to                                                                                                                                                     a registered agent/office will result in revocation proceedings. 
   this address.
6. State the specific purpose(s) of the corporation which                                                                                                                                                      Every entity registered with the RI Department of State - 
   it proposes to pursue in conducting its affairs in Rhode                                                                                                                                                    Business Services Division will have filing requirements with 
   Island.                                                                                                                                                                                                     the Rhode Island Division of Taxation, even if no business 
                                                                                                                                                                                                               is conducted within Rhode Island for a particular year. Your 
7. List the names and addresses of the corporation’s 
                                                                                                                                                                                                               business may require additional licensing. Please visit our 
   directors and officers.  
                                                                                                                                                                                                               website for further information.
8.  A Certificate of Good Standing/Letter of Status from the 
   state or country of formation dated within 60 days of the                                                                                                                                                   Your entity may also be required to report (and update, if 
   date of this filing must accompany this application.                                                                                                                                                        necessary) information about the business and its beneficial 
9.  The President or Vice President AND the Secretary or                                                                                                                                                       owners to the U.S. Department of Treasury’s Financial 
   Assistant Secretary MUST sign and date the form.                                                                                                                                                            Crimes Enforcement Network (FinCEN). Visit FinCEN.gov/
                                                                                                                                                                                                               boi for more information.

                                                                                                                                                                                                                                                     FORM 250 - Revised:  8/2023



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        State of Rhode Island
        Department of State - Business Services Division

Certificate of Authority
FOREIGN Non-Profit Corporation                                                                                                                     STAMP 
        Filing Fee:  $50.00                                                                                                                        FOR
                                                                                                                                                   SECRETARY OF STATE 
                                                                                                                                                   USE ONLY

Pursuant to the provisions of RIGL 7-6-74, the undersigned foreign non-profit corporation hereby 
applies for a Certificate of Authority to conduct affairs in the State of Rhode Island, and for that 
purpose submits the following statement:
1. The name of the corporation is:

1a. The name, if different, which it elects to use in Rhode Island is:
*If the corporate name is not available in Rhode Island, then set forth below the fictitious name under which the 
corporation will qualify and transact business in Rhode Island as stated in the “Fictitious Business Name Statement” to be 
filed with this application.

2. It is incorporated under the laws of: 

3. The date of its incorporation is:

And the period of its duration is:  CHECK ONLY ONE BOX
Perpetual (on-going)

Date certain for dissolution ___________________________________________________

4. The address of its principal place of business is:

5. The name and address of the initial registered agent/office in Rhode Island is:
Agent Name 

Street Address (NOT a P.O. Box)

City/Town                                                                                                                         State    Zip Code
                                                         RHODE ISLAND

MAIL TO:
Division of Business Services
148 W. River Street, Providence, Rhode Island 02904-2615                                                                                           STAMP 
Phone: (401) 222-3040                                                                                                                              FOR
Website: www.sos.ri.gov                                                                                                                            SECRETARY OF STATE 
                                                                                                                                                   USE ONLY

                                                                                                                                           FORM 250 - Revised:  12/2023



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6. The purpose or purposes which it proposes to pursue in the conducting its affairs in Rhode Island:

                                                                                                                             Check the box to indicate an attachment
7. The names and respective addresses of its directors and officers are:
OFFICE   NAME                                               ADDRESS

Director

Director

Director

President

Vice 
President

Treasurer

Secretary

                                                                                                                             Check the box to indicate an attachment
8. This application must be accompanied by a Certificate of Good Standing/Letter of Status from the state or country of 
formation dated within 60 days of the date of this filing.
Under penalty of perjury, we declare and affirm that we have examined this Application for Certificate of Authority, including 
and accompanying attachments, and that all statements contained herein are true and correct.
Type or Print Name of      President OR      Vice President                                                            Date

Signature of President OR Vice President

Type of Print Name of       Secretary OR       Assistant Secretary                                                     Date

Signature of Secretary OR Assistant Secretary

TWO SIGNATURES ARE REQUIRED

If you have any questions, please call us at (401) 222-3040, Monday through Friday, 
between 8:30 a.m. and 4:30 p.m., or email corporations@sos.ri.gov.
                                                                                                                           FORM 250 - Revised:  8/2023



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        State of Rhode Island
        Department of State - Business Services Division

Filer Contact Information
        
In the event our office needs more information in order to complete the filing of this document, we ask for the 
filer’s contact information. All fields are REQUIRED.

Name:                                                                               Date:

Proposed Entity Name:

Street Address:

City:                                                State:                         Zip Code:

Email Address:                                                                      Phone Number: 

If you have any questions, please call us at (401) 222-3040, Monday through Friday, 
between 8:30 a.m. and 4:30 p.m., or email corporations@sos.ri.gov.
                                                                                         FORM 250 - Revised:  12/2023






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