INFORMATION CONCERNING FORMATION OF A DENTAL CORPORATION

 

 

 

1.       The attached application to form a dental corporation shall be completed.

 

2.       Only duly licensed dentists shall incorporate or become incorporators for a dental corporation.

 

3.       All dental corporations shall be in the name of the individual licensed dentist and/or licensed dentists only.  (ie. Dr. John B. Doe, Inc.; John B. Doe, DDS, Inc.; Drs. Doe and Smith, Inc.; or Doe and Smith, DDS, Inc.)

DO NOT ADD DISCRIPTIVE WORDS IF APPROVAL IS DESIRED.

 

4.       All applications to form a dental corporation shall have two original copies of the Articles of Incorporation attached.

 

5.       Fee of $200.00 payable to the West Virginia Board of Dental Examiners must accompany application.

 

6.       Annually, each corporation shall register on a from provided by the West Virginia Board of Dental Examiners and pay an annual registration fee of $150.00.

 

7.       All Articles of Incorporation shall contain within the purpose clause:   "Said corporation will abide by the laws of the State of West Virginia, more specifically, Chapter 30, Articles 1, et seq., and 4, et seq."

 

 

 

 

                             APPLICATION TO FORM DENTAL CORPORATION

 

NAME OR NAMES OF DULY                             WEST VIRGINIA                    DATE

  LICENSED DENTISTS                                         LICENSE NO.                  ISSUED

                                                                                                                     

(1)

 

(2)

 

(3)

 

(4)

 

(5)

 

If there are more than five applicants, please use reverse side of application.

 

The above named applicants hereby certify that they are duly licensed to practice dentistry in the State of West Virginia and desire to form a dental corporation.

 

                                                                            

 

                                                                               

 

                                                                               

 

                                                                             

 

                                                                                

 

(Above personal signatures of applicants are to be certified by a notary public.)

 

Taken, subscribed, and sworn to before the undersigned this                day of

                              , 20__.

My commission expires                                                                    .

                                                                                                                 

                                                                NOTARY PUBLIC

Two original copies of the Articles of Incorporation shall be attached to and made a part of this application.  Further, please enclose a check or money order in the amount of $200.00 payable to the West Virginia Board of Dental Examiners, no part of which is refundable.  Also enclose the check made payable to the Secretary of State=s office unless it has already been paid to the Secretary of State.  Please return application and necessary papers to Susan Combs, Administrative Secretary, West Virginia Board of Dental Examiners, 1319 Robert C. Byrd Drive, PO Box 1447, Crab Orchard, WV 25827.

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