Form Cin 1 1 0 – Fill Out and Use This PDF

SECRETARY OF THE STATE OF CONNECTICUT

MAILING ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, P.O. BOX 150470, HARTFORD, CT 06115-0470

DELIVERY ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, 30 TRINITY STREET, HARTFORD, CT 06106

PHONE: 860-509-6003

WEBSITE: www.concord-sots.ct.gov

CERTIFICATE OF INCORPORATION

NONSTOCK CORPORATION

USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. ATTACH 81/2 X 11 SHEETS IF NECESSARY.

1. NAME OF CORPORATION:

THE CORPORATION IS NONPROFIT AND SHALL NOT HAVE OR ISSUE SHARES OF STOCK OR MAKE DISTRIBUTIONS.

2. PLACE A CHECK NEXT TO THE APPROPRIATE STATEMENT: A. THE CORPORATION SHALL NOT HAVE MEMBERS.

B. THE CORPORATION SHALL ONLY HAVE MEMBERS, WHICH ARE NOT ENTITLED TO VOTE.

C. THE CORPORATION SHALL HAVE ONE CLASS OF MEMBERS.

D. THE CORPORATION SHALL HAVE MULTIPLE CLASSES OF MEMBERS WHICH CLASSES ARE DESIGNATED AS FOLLOWS:

PLEASE NOTE: THE MANNER OF ELECTION AND APPOINTMENT OF MEMBERS ALONG WITH THEIR QUALIFICATIONS AND RIGHTS MAY BE SET FORTH IN THIS CERTIFICATE OR IN THE CORPORATION'S BYLAWS. PLEASE SEE C.G.S.§ 33-1055 & -1056.

3. APPOINTMENT OF REGISTERED AGENT:(PLEASE SELECT ONLY ONE A. OR B.)

A. INDIVIDUAL'S AGENT NAME:

BUSINESS ADDRESS: (P.O.BOX UNACCEPTABLE)		RESIDENCE ADDRESS: (P.O.BOX UNACCEPTABLE)
ADDRESS:		ADDRESS:
CITY:		CITY:
STATE:	ZIP:	STATE:	ZIP:

ACCEPTANCE OF APPOINTMENT

SIGNATURE OF AGENT

4.THE NATURE OF THE ACTIVITIES TO BE CONDUCTED OR THE PURPOSES TO BE PROMOTED BY THE CORPORATION:

5.OTHER INFORMATION:

6.EXECUTION: CERTIFICATE MUST BE SIGNED BY EACH INCORPORATOR

DATED THIS			DAY OF		, 20
NAME OF INCORPORATOR				ADDRESS		SIGNATURE(S)
		ADDRESS:

CITY

STATE:ZIP:

ADDRESS:

CITY

STATE:ZIP:

ADDRESS:

CITY

STATE:ZIP:

ADDRESS:

CITY

STATE:ZIP:

	PAGE 2 OF 2	FORM CIN-1-1.0
		Rev. 8/2011

INSTRUCTIONS

1.NAME OF CORPORATION: Please provide the name of the corporation. The name of the corporation must contain

one of the following designations: "corporation", "incorporated", or "company", or the abbreviation "corp.", "inc." or "co.", or words or abbreviations of like import in another language. The name must also be distinguishable from other business names on the records of the Secretary of the State.

2.PLACE A CHECK NEXT TO THE APPROPRIATE STATEMENT: Please provide required membership information

by making the appropriate selection. Note: if (D) is selected, the corporation must designate each class of members in the space provide or in an attachment.

3.APPOINTMENT OF REGISTERED AGENT: The corporation may not appoint itself as its registered agent. The corporation may appoint either a natural person who is a resident of Connecticut; a Connecticut corporation, limited liability company, limited liability partnership, or statutory trust; or a foreign corporation, limited liability company, limited liability partnership or statutory trust which has procured a certificate of authority to transact business in Connecticut. Please note the following: if the agent being appointed is a natural person, that person's business address must be provided under the heading Business office address and their residence address under the heading Residence address; if the agent appointed is an entity, it must provide its principal office address under the Business office address heading; the agent must sign accepting the appointment in the space provided; the signatory must Print their name and the capacity under which they sign if signing on behalf of an entity; and all addresses must include a street number, street name, city, state, postal code. P.O. box addresses are acceptable ONLY as additional information.

4.THE NATURE OF THE ACTIVITIES TO BE CONDUCTED OR THE PURPOSES TO BE PROMOTED BY THE CORPORATION: Please provide the purpose for which the corporation is formed. Nonstock corporations are permitted to state that the purpose of the corporation is to engage in any lawful act or activity for which corporations may be formed under the Connecticut Revised Nonstock Corporation Act in lieu of or in addition to a specific purpose.

5.OTHER INFORMATION: Please present in the space provided or on an attachment any information which a nonstock corporation is permitted but not required to provide.

6.EXECUTION: The document must be executed by one or more incorporators, each of whom must provide an address containing a street and number, city, state and a postal code. The execution constitutes legal statement under the penalties of false statement that the information provided in the document is true.

INCORPORATION OF A CONNECTICUT NONSTOCK CORPORATION

ANY QUESTIONS CONCERNING THE COMPLETION OF THIS FORM, OR THE INCORPORATION PROCESS

SHOULD BE DIRECTED TO YOUR LEGAL COUNSEL.

Note: Please contact the Department of Revenue Services or your tax advisor as to any potential tax liability relating to

your business.

Please note that the filing of the above referenced documents represent the bare essentials of incorporating a

non-stock, nonprofit company in Connecticut. There are many other considerations to consider. For example, if you

wish the corporation to be exempt from federal taxes, you should contact the Internal Revenue Service prior to filing to

determine whether the corporation's Certificate of Incorporation should contain any specific provisions. Further, any

person or organization planning to grant college credit or call itself a college or university must first comply with Section

10a-34 of the Connecticut General Statutes before it will be accepted as a corporation.

Please make check(s) or money order(s) payable to: SECRETARY OF THE STATE