State of California
File#_________________________
Bill Jones
Secretary of State
LIMITED LIABILITY COMPANY
APPLICATION FOR REGISTRATION
A $70.00 filing fee must accompany this form.
IMPORTANT – Read instructions before completing this form.
This Space For Filing Use Only
Name under which the foreign limited liability company proposes to register and transact business in California:
1.
(End the name with the words “Limited Liability Company,” ” Ltd. Liability Co.,” or the abbreviations “LLC” or “L.L.C.”)
2.
Name of the foreign limited liability company, if different from that entered above:
This foreign limited liability company was formed on
in
3.
(month)
(day)
(year)
(state or country)
and is authorized to exercise its powers and privileges in that state.
Name of the agent for service of process in this state, and check the appropriate provision below:
4.
, which is
[
] an individual residing in California. Proceed to item 5.
[
] a corporation which has filed a certificate pursuant to Section 1505 of the California Corporations Code. Proceed to item 6.
If an individual, California address of the agent for service of process:
5.
Address:
City:
State: CA
Zip Code:
6.
In the event the above agent for service of process resigns and is not replaced, or if the agent cannot be found or served
with the exercise of reasonable diligence, the Secretary of State of the State of California is hereby appointed as the agent for
service of process of this foreign limited liability company.
Address of the principal executive office:
City
State
Zip Code
7.
Address of the principal office in California, if any:
City
State
Zip code
8.
CA
9. Type of business of the limited liability company: (For information purposes only.)
10.
DECLARATION: It is hereby declared that I am the person who executed this instrument, which execution is my act and deed.
Signature of Authorized Person
Type or Print Name and Title of Authorized Person
Date
11. RETURN TO:
NAME
FIRM
ADDRESS
CITY/STATE
ZIP CODE
SEC/STATE (REV. 12/99)
FORM LLC-5 – FILING FEE $70.00
Approved by Secretary of State