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APPLICATION FOR CERTIFICATE OF AUTHORITY
CONNIE LAWSON
OF A FOREIGN LIMITED LIABILITY COMPANY
SECRETARY OF STATE
BUSINESS SERVICES DIVISION
State Form 49464 (R5 / 5-14)
302 W. Washington Street, E018
Approved by State Board of Accounts, 2014
Indianapolis, Indiana 46204-2700
Telephone: (317) 232-6576
INSTRUCTIONS:
1. Use 8 1/2" x 11" white paper for attachments.
2. Present original and one (1) copy to the address on upper right corner of this form.
3. Please TYPE or PRINT in INK.
Indiana Code 23-18-11-4
4. Please visit our office at
5. Make check or money order payable to Secretary of State.
FILING FEE: $ 90.00
NOTES:
1. Applicant must submit a certificate of existence issued by the proper authority within the last
sixty (60) days.
APPLICATION FOR CERTIFICATE OF AUTHORITY
OF
The undersigned manager or member desiring to effectuate the admittance of the above Limited Liability Company (LLC) to transact business in the State
of Indiana, certifies the follow facts:
ARTICLE I: NAME AND PRINCIPAL OFFICE
Fictitious Name (Only used if name in the application is not available in Indiana.)
Address of the Principal Office (number and street)
City
State
ZIP code
ARTICLE II: REGISTERED OFFICE AND REGISTERED AGENT
Name of the Registered Agent (Cannot be organization itself.)
Address of Registered Office (number and street) (PO Box not accepted)
City
ZIP code
State
IN
Required:
By checking the box, the Signator(s) represents that the registered agent named in the application has consented to the appointment
of registered agent.
ARTICLE III: DATE OF ORGANIZATION AND DURATION OF EXISTENCE
State of organization
Date of organization in domicilary state (month, day, year)
The LLC is perpetual until dissolution.
OR
The latest date upon which the LLC is to dissolve (month, day, year):
ARTICLE IV: MANAGEMENT
The Articles of Organization state that the LLC is to be managed by its member or members.
The Articles of Organization provide for a manager or managers.
In witness whereof, the undersigned being the___________________________________________________ of said LLC executes this Application for
(Manager or member)
Certificate of Authority, and verifies subject to penalties of perjury, that the facts contained herein are true this __________________________
day of __________________________ , 20_______.
Signature
Printed name