Cover Letter Template Registration Section Division Of Corporations Page 5

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ARTICLE IV- Manager(s) or Managing Member(s):
The name and address of each Manager or Managing Member is as follows:
Title:
Name and Address:
"MGR" = Manager
"MGRM" = Managing Member
(Use attachment if necessary)
ARTICLE V: Effective date, if other than the date of filing:
.
(OPTIONAL)
(The effective date: 1) cannot be prior to nor more than 90 days after the date this document is filed by
the Florida Department of State; AND 2) must be the same as the effective date listed in the attached
Certificate of Conversion, if an effective date listed therein.)
REQUIRED SIGNATURE:
_________________________________________________
Signature of a member or an authorized representative of a member.
(In accordance with section 608.408(3), Florida Statutes, the execution of this document constitutes an affirmation under
the penalties of perjury that the facts stated herein are true. I am aware that any false information submitted in a
document to the Department of State constitutes a third degree felony as provided for in s.817.155, F.S.)
_________________________________________________________
Typed or printed name of signee
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