Application For Registration As A Professional Limited Liability Company - 2006 Page 2
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1
2MANAGERS OF THE LIMITED LIABILITY COMPANY
This Section Must be Completed. List all managers of the limited liability company who are required
by Nebraska law to be licensed or certified to perform the professional services for which the limited
liability company was organized. (use additional sheets if needed)
_____________________________________
____________________________________
Full Name & License #
Residence Street Address, City, State, Zip
_____________________________________
____________________________________
Full Name & License #
Residence Street Address, City, State, Zip
_____________________________________
____________________________________
Full Name & License #
Residence Street Address, City, State, Zip
_____________________________________
____________________________________
Full Name & License #
Residence Street Address, City, State, Zip
_____________________________________
____________________________________
Full Name & License #
Residence Street Address, City, State, Zip
_____________________________________
____________________________________
Full Name & License #
Residence Street Address, City, State, Zip
PROFESSIONAL EMPLOYEES OF THE LIMITED LIABILITY COMPANY
This Section Must be Completed. List all professional employees of the limited liability company
who are required by Nebraska law to be licensed or certified to perform the professional services for
which the limited liability company was organized. (use additional sheets if needed)
_____________________________________
____________________________________
Full Name & License #
Residence Street Address, City, State, Zip
_____________________________________
____________________________________
Full Name & License #
Residence Street Address, City, State, Zip
_____________________________________
____________________________________
Full Name & License #
Residence Street Address, City, State, Zip
_____________________________________
____________________________________
Full Name & License #
Residence Street Address, City, State, Zip
_____________________________________
____________________________________
Full Name & License #
Residence Street Address, City, State, Zip
_____________________________________
____________________________________
Full Name & License #
Residence Street Address, City, State, Zip
_____________________________________ or ____________________________________
Signature of Member
Signature of Manager
________________________Date
/
/
or ______________________Date
/
/
Printed Name of Member
Printed Name of Manager
Revised 9/25/2006
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Parent category: Legal