For Office Use Only
CERTIFICATE OF FORMATION
(LIMITED LIABILITY COMPANY)
Corporate Filings
312 Eighth Avenue North
6
Floor, William R. Snodgrass Tower
th
Nashville, TN 37243
Pursuant to the provisions of §48-203-102 of the Tennessee Limited Liability Company Act or §48-249-
201 of the Tennessee Revised Limited Liability Company Act, the undersigned hereby submits the following
statement.
1. The Limited Liability Company was formed and the date of formation is _____________________.
(month, day and year)
Signature Date
Name of Limited Liability Company
Signer’s Capacity
Signature
Name (typed or printed)
SS-4232 (Rev. 01/06)
Filing Fee: $20
RDA 2458