Form Dfi/corp/521 - Foreign Limited Liability Company - Certificate Of Registration Application Page 2

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7. Management of the foreign limited liability company is vested in:
a manager or managers
its members
8. Has the company transacted business in Wisconsin without holding a certificate of
registration?
No
Yes
If yes, state the period
and
complete the supplement below. (see instructions)
SUPPLEMENT
Basic registration fee
$
100.00
PLUS annual report fee for each year (each calendar year X fee)
1995 through 2001, $50 each year;
2002 thru
$80 each year
$ ______________
Subtotal
$ ______________
Calculate and ADD a 50% penalty to the subtotal, or
$5,000, whichever is less
$ ______________
TOTAL FILING FEE (post to item 9)
$ ______________
FILING FEE
9. Remit the one appropriate
, payable to Department of Financial Institutions:
ORIGINAL Certificate
ORIGINAL Certificate,
AMENDED Certificate
from Supplemental above
OR
OR
$ 100.00
$ 40.00
$____________________
10. I certify that the applicant is a foreign limited liability company.
Executed on
(Date)
(Signature)
Title:
Member OR
Manager
(Select and mark (X) the appropriate title)
(Printed name)
RESET FORM
DFI/CORP/521 (04/15)
2

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