Form 367 - Limited Liability Company Supplemental Initial Report

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W. Fox McKeithen
Secretary of State
LIMITED LIABILITY COMPANY
SUPPLEMENTAL INITIAL REPORT
(R.S. 12:1305)
Domestic Limited Liability Company
Return to: Corporation Division
Enclose $20.00 filing fee
P. O. Box 94125
Make Remittance Payable to
Baton Rouge, La 70804-9125
Secretary of State
Phone (504) 925- 4704
Do not send cash
1. The name of this limited liability company is: ___________________________________________
2. The name and municipal addresses (not a P.O. Box only) of the first managers or the members are:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
To be signed by each person who signed the Articles of Organization:
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
367 Rev. 4/97
(See instructions on back)

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