Authentication Request Form - Louisiana Secretary of State
[Pages:1]AUTHENTICATION REQUEST FORM
Sender's Name:
____________________________________________________________________
Company's Name: ____________________________________________________________________
Address:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Daytime telephone number: ______________________________________________________________
Email address:
______________________________________________________________
Country in which documents will be used: __________________________________________________
Make sure that all documents are properly notarized or certified
Number of documents: ___________ x $10.00 (adoptions) = Number of documents: ___________ x $20.00 (all others) =
_________________________Total due _________________________Total due
Make payable to: Secretary of State
Check __________ Money Order _________
_____Visa _____Mastercard _____American Express _____Discover
Credit card number: _______________________________________________ **State Fee/Credit Card Users $5.00
Expiration date: __________________________________________________
Type of return mailer enclosed:
______ Self-addressed first class envelope with postage ______ Self-addressed U.S. Postal Service Priority or Express with postage ______ Self-addressed carrier label (FedEx, UPS, DHL) with account number
Submitting overnight delivery supplies does not guarantee overnight processing. Allow two (2) to three (3) business days for documents to be processed by our office. If you need immediate service, please call for additional information at 225.922.0330.
SEND COMPLETED FORM WITH PAYMENT AND ALL DOCUMENTS TO:
Secretary of State Commissions Division
8585 Archives Ave. Baton Rouge, LA 70809
................
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