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Expedited Request By Fax Cover Sheet - Corporate Charter Division - Maryland

Expedited Request By Fax Cover Sheet - Corporate Charter Division Form. This is a Maryland form and can be used in Business Entity Secretary Of State .
 Fillable pdf Last Modified 1/13/2015
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Maryland SDAT CORPORATE CHARTER DIVISION Expedited Request by Fax Cover Sheet Note: All faxed filings and requests are expedited and an expedited filing surcharge beyond the processing fee applies to each request. See Fee Schedule at for the appropriate fees or e-mail the division at or telephone for new filings only 410-767-1340, for all other calls 410-767-1350. _____________________________________________________________________________________________________________________ Fax all requests to 410-333-7097 Please type or print legibly, you may also fill this form out on your pc. Name of entity:____________________________________________________________________________________________ Fax number:___________________________________________________ Phone number:_________________________________________________ Number of pages transmitted:__________________ Contact person:__________________________________________________________ Name and address for return mail:_____________________________________________________________________________ ________________________________________________________________________________________________________ SERVICE REQUESTED NEW ENTITY FILING Check all that apply. File document Return original document Note a $5.00 fee applies to this service _______Number of certified copies _______Number of certificates Certified copies of document being filed Short form Certificate of Status RECORD REQUEST Department ID number____________________________________ Entity name______________________________________________________________________________________________ Certificate of Status for existing entity Copies of documents previously recorded ________Number of certificates Attach separate sheet and specify: the name and title of each document; the date of recording, if known; liber and folio, if known; the number of copies wanted for each document. _____________________________________________________________________________________________________________________ This transaction will not be accepted without the following: CREDIT CARD INFORMATION O MASTERCARD O VISA (At this time we only accept Mastercard and VIsa) Cardholder's name______________________________________________________________________________ Credit card number_____________________________________________________________________________ Billing address and zip code ______________________________________________________________________ _____________________________________________________________________________________________ Expiration date____________________________________ 3 Digit security code____________________________ Signature of Cardholder__________________________________________________________________________ ============================FOR DEPARTMENTAL USE ONLY================================= AUTH NO.______________________CLERK:__________________FEE:____________________ Revised: 10/8/14 American LegalNet, Inc.
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