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District of Columbia Government

Corporations Division

PO Box 92300

Washington DC 20090

Application for Certificate of Registration for Foreign Limited Liability Company

Use this form to register your foreign Limited Liability Company (LLC).

ENTITY TYPE

FILING FEE

Foreign Limited Liability Company

$200, payable to DC Treasury

Under the provisions of the Limited Liability Company Act, DC Official Code Title 29 Chapter 10, the company listed below hereby

applies for a Certificate of Registration to transact business in the District of Columbia, and for that purpose submits the statement

below.

1. 1. Entity Name

2. Company Designation elected in the District of Columbia. (Add LLC

or PLLC if this designation is not required by the state of organization.)

3. Organized under the laws of which state or country

4. 4. Date of Organization

. 5. Term of Existence

6. Date company started or will start transacting business in the

District of Columbia. (If you started business before you registered,

you must file a 2-year report and pay applicable fees.)

7. Address of the company in the state where it is organized. (If the

8. Registered Agent’s name and address of registered office in District

principal address is outside the state of organization, give the RA in

of Columbia. (Attach Form RA-1 for RA’s consent to this application.)

the state of organization.)

9. Briefly describe the proposed activity company will transact in the District of Columbia. (General purposes are acceptable in combination

with specific purposes.)

10. List all managers and members of the Limited Liability Company

TITLE

NAME

ADDRESS

11. It is authorized to pursue such purpose in the state or country under the laws of which it is organized.

12 Attach an original Certificate of Good Standing (Certificate of Existence) from Registration Authority in the State/Country of Incorporation

that is not over 30 days old. (Certificate of good standing from Tax or Licensing Authority will not be sufficient.)

If you sign this application, you agree that you understand that anyone who makes a false statement anywhere on it can

be punished by criminal penalties of a fine up to $1000, imprisonment up to 180 days, or both, under DCOC § 22-2405.

13. Select Company Representative executing this form

14. Signature

Manager

Member

Authorized Person

Mail all forms and required payment to:

For overnight delivery send to:

Corporate Bank of America

Department of Consumer and Regulatory Affairs

Attention: DC Government

Corporations Division

Wholesale Lockbox #92300

PO Box 92300

Mail Code MD4-301-18-04

Washington, DC 20090

225 North Calvert Street – 18

floor

Phone: (202) 442-4432

Baltimore, Maryland 21202

Please check dcra.dc.gov to view organizations required to register, to search business names, to get step-by-step guidelines to register an

organization, to search registered organizations, and to download forms and documents. Just click on “Corporate Registrations.”

Application For Certificate Of Registration For Foreign Limited Liability Company, Form Ra-1 - Registered Agent Written Consent

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