Form Pllc-01 , Application For Certificate Of Authority Page 2
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4State of North Carolina
Department of the Secretary of State
APPLICATION FOR CERTIFICATE OF AUTHORITY
FOREIGN PROFESSIONAL LIMITED LIABILITY COMPANY
Pursuant to Sections 57D-2-02, 57D-7-03, and 55B-16 of the General Statutes of North Carolina, the undersigned limited
liability company hereby applies for a Certificate of Authority to transact business in the State of North Carolina as a
“foreign professional limited liability company” within the scope of N.C.G.S. Sections 57D-2-02 and 55B-16(b) and for
that purpose submits the following:
1. The name of the limited liability company is __________________________________________________________;
and if the limited liability company name is unavailable for use in the State of North Carolina, the name the limited
liability company wishes to use is ___________________________________________________________________
2. The state or country under whose laws the limited liability company was organized is: _________________________
3. The street address of the principal office of the limited liability company in the state or country under whose law it is
organized is:
Number and Street: ______________________________________________________________________________
City: __________________________________________ State: ________________ Zip Code: _________________
4. The mailing address if different from the street address of the principal office of the limited liability company in the
state or country under whose law it is organized is:
Number and Street or PO Box: ____________________________________________________________________
City: __________________________________________ State: ________________ Zip Code: _________________
5. The street address and county of the registered office in the State of North Carolina is:
Number and Street: _______________________________________________________________________________
City: ____________________ State: NC Zip Code: _____________ County ________________________________
6. The mailing address if different from the street address of the registered office in the State of North Carolina is:
Number and Street or PO Box: ______________________________________________________________________
City: ____________________ State: NC Zip Code: _____________ County ________________________________
7. The name of the registered agent in the State of North Carolina is: _________________________________________
CORPORATIONS DIVISION
PO BOX 29622
RALEIGH, NC 27626-0622
Revised January, 2014
Form PLLC-01
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