Certificate of Formation Form 204

Step 1 of 6 - Individual/Entity

Application Filing Fee(Required)

Price:

Unique ID

Are you filing as an Individual or a Business?(Required)

Individual

Business/Entity

Requestor Name(Required)

Entity Type(Required)

What is the name of the entity?(Required)

The name must contain the word “associated,” “associates,” “association,” “professional association” or an abbreviation of one of these terms.

Registered Agent (Same As Above)

Yes

Registered Agent Name(Required)

Registered Agent Office Address(Required)

Street Address Address Line 2 City State ZIP Code

Will the Initial Registered Agent be an Individual resident of the state, or an organization (cannot be entity named above)?(Required)

Please provide the Initial Registered Agent’s Name(Required)

Please provide the Initial Registered Agent’s Business Address(Required)

Street Address Address Line 2 City State ZIP Code

Governing Person(s) - A MINIMUM of 1 individual is required

Will this professional association be managed by a board of directors or an executive committee?(Required)

Name (Director 1)(Required)

First Last

Address (Director 1)(Required)

Street Address Address Line 2 City State ZIP Code

Add additional parties? (Governing Persons)

Yes

Name (Director 2)

First Last

Address (Director 2)

Street Address Address Line 2 City State ZIP Code

Name (Director 3)

First Last

Address (Director 3)

Street Address Address Line 2 City State ZIP Code

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Governing Person(s) (A MINIMUM of 1 Indvidual is Required)

Please list the names and addresses of the Original Members

Original Member must sign the certificate of formation

Name (Member 1)(Required)

First Last

Address (Member 1)(Required)

Street Address Address Line 2 City State ZIP Code

Add additional parties? (Original Members)

Yes

Name (Member 2)

First Last

Address (Member 2)

Street Address Address Line 2 City State ZIP Code

Name (Member 3)

First Last

Address (Member 3)

Street Address Address Line 2 City State ZIP Code

This field is hidden when viewing the form

Please list the names and addresses of the Original Members

Original Member must sign the certificate of formation

go back to entity formation

Certificate of Formation Form 204

Governing Person(s) - A MINIMUM of 1 individual is required

Please list the names and addresses of the Original Members

Execution

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