State Form 49464 - Application For Certificate Of Authority Of A Foreign Limited Liability Company - Indiana
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1TO DD RO KITA
APPLICATION FOR CERTIFICATE OF
S ECRE TARY O F STATE
AUTHORITY OF A FOREIGN LIMITED LIABILITY COMPANY
CO RP ORATIONS DIVISION
302 W. Washing ton St., Rm. E018
State For m 494 64 (R / 1-0 3)
In dianap olis, IN 4620 4
Telepho ne: (317) 23 2-6576
Ap proved By S tate Board Of Accounts 19 99
Indian a Code 23 -18-11-4 et seq.
INSTRUCTIONS:
Use 8 1/2" x 11" white paper for attachments.
Present original and one (1) copy to the address in upper right corner of this form.
FILING FEE: $90.00
Please TYPE or PRINT.
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This application cannot be accepted without an original certificate of existence duly authenticated by the proper authority
from the LLC's domicilary state within the last sixty (60) days.
This application cannot be accepted unless a registered agent with an Indiana street address is listed in ARTICLE II.
APPLICATION FOR CERTIFICATE OF AUTHORITY
OF
A FOREIGN LLC
TO TRANSACT BUSINESS IN THE STATE OF INDIANA
The undersigned manager or member of the above ______________________________________________________________ LLC
(State of Domicile)
desiring to effectuate the admittance of the LLC to transact business in the State of Indiana, under the name of
_________________________________________________________________________________ certifies the following facts:
( if using an assumed bu sin ess name sp ecify n ame ab ove)
ARTICLE I: Name and Principal Office
Name of LLC ( Must be id entical to n ame sho wn in Arti cles of Or ganization and Amendments thereto)
Addre ss of the p rincipal office of LLC (Number and stree t, city, state and ZIP co de)
ARTICLE II: Registered Office and Registered Agent
Name o f th e re gistere d a gent o f th e L LC
In diana ad dress of the registered office of LL C (Number and stre et, city, sta te and Zip co de)
ARTICLE III: Date of Organization and Duration of Existence
Date o f o rganization in domicilary state
Expected period of duration liste d in the A rticles o f Orga nizatio n
ARTICLE IV: Management
The Articles of Organization state that the LLC is to be managed by its members.
The Articles of Organization provide for a manager or managers.
In witness whereof, the undersigned being the___________________________________________________ of said LLC executes this
(Man ager or me mb er)
Application For Certificate Of Authority, and verifies subject to penalties of perjury, that the facts contained herein are true this
__________________day of __________________________ , 20_______.
S ig na tur e
Pr inted name
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