Form Pllc-03 - Application For Amended Certificate Of Authority (Professional Limited Liability Company)

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State of North Carolina
Department of the Secretary of State
APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY
(PROFESSIONAL LIMITED LIABILITY COMPANY)
Pursuant to § 57C-7-05 and Chapter 55B of the General Statutes of North Carolina, the undersigned limited
liability company hereby applies for an Amended Certificate of Authority to transact business in the State of
North Carolina, and for that purpose submits the following statement.
1.
The name of the limited liability company is:_______________________________________________
2.
The name the limited liability company is using in the State of North Carolina is:
____________________________________________________________________________________
3.
The state or country of organization is:____________________________________________________
4.
The date the limited liability company was authorized to transact business in the State of North Carolina
is:__________________________________________________________________________________
5.
The personal services to be rendered by the limited liability company
are:_________________________
____________________________________________________________________________________
____________________________________________________________________________________
6.
With respect to each professional service practiced or to be practiced through the limited liability
company in this State, the name of at least one of the limited liability company’s managers who is a
licensee of the licensing board which regulates such profession in this State is: (insert name here)
7.
Attached are certifications by the appropriate licensing boards that each person set forth in Item 6 above
is a “licensee” as defined in N.C.Gen. Stat. § 55B-2(2).
8.
This application is filed for the following reason (complete all applicable items):
a.
The limited liability company has changed its corporate name to:_________________________
_____________________________________________________________________________
b.
The name the limited liability company will hereafter use in the State of North Carolina is
changed to:____________________________________________________________________
c.
The limited liability company has changed its period of duration to:_______________________
d.
The limited liability company has changed the state or country of its organization to:
_____________________________________________________________________________
e.
(Other)_______________________________________________________________________
_____________________________________________________________________________
(Revised January 2000)
(Form PLLC-03)
CORPORATIONS DIVISION
P. O. BOX 29622
RALEIGH, NC 27626-0622

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