252
CERTIFICATE OF ORGANIZATION
Click here to clear form.
PROFESSIONAL
LIMITED LIABILITY COMPANY
(Instructions on back of application)
1. The name of the professional limited liability company is:
___________________________________________________________________
2. The complete street and mailing addresses of the initial designated office:
___________________________________________________________________
(Street Address)
___________________________________________________________________
(Mailing Address, if different than street address)
3. The name and complete street address of the registered agent:
_________________________
______________________________________
(Name)
(Street Address)
4. The name and address of at least one member or manager of the professional limited
liability company:
Name
Address
___________________________
______________________________________
___________________________
______________________________________
___________________________
______________________________________
___________________________
______________________________________
5. Mailing address for future correspondence (annual report notices):
___________________________________________________________________
6. Future effective date of filing (optional): ____________________________________
7. The limited liability company is a professional company, and the principal profession or
professions for which members are duly licensed or otherwise legally authorized to render
professional services is: ______________________________________________
Signature of a manager, member or authorized
person.
Secretary of State use only
Signature _______________________________
Typed Name: ___________________________
Signature _______________________________
Typed Name: ___________________________
cert_org_pllc.pmd
Rev. 07/2010