Mississippi Llc Certificate Of Formation Template
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211 F0100
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OFFICE OF THE SECRETARY OF STATE
P O BOX 136, JACKSON, MS 39205-0136
(601)359-1633
Mississippi LLC Certificate of Formation
The undersigned hereby executes the following document and sets forth:
(fields marked with an asterisks are required)
1. Name of the Limited Liability Company:
(The name must include the words “Limited Liability Company” or the
abbreviation “LLC” or “L.L.C.”)
*
2. The future effective date is
Business Email Address:____________________________
(Complete if Applicable)
3. Federal Tax ID if available (Do not put Social Security Number in the box)
4. Name and Street Address of the Registered Agent and Registered Office is (must be in Mississippi)
*Name
*Physical
Address
P.O. Box
MS
*City
*
State
*
Zip5 – Zip4
5. If the Limited Liability Company is to have a specific date of dissolution, the latest date upon which the Limited
Liability Company is to dissolve is
6. Is full or partial management of the Limited Liability Company vested in a manager or managers? (Mark Appropriate
box)
*
Yes
No
7. Other matters the managers or members elect to include: (Attach additional pages if necessary)
Rev. 04/2009
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