LLC-1052
COMMONWEALTH OF VIRGINIA
(07/00)
STATE CORPORATION COMMISSION
APPLICATION FOR REGISTRATION AS A FOREIGN
LIMITED LIABILITY COMPANY
1. The name of the foreign limited liability company is
____________________________________________________________________________.
2. The name under which foreign the limited liability company proposes to register and transact
business in Virginia is (if different from number 1)
____________________________________________________________________________.
(The name must contain the words "limited company" or "limited liability company" or their
abbreviations "L.C.", "LC", "L.L.C." OR "LLC")
3. The foreign limited liability company was formed under the laws of
___________________________________________ on ______________________________.
(state or country)
(date of formation)
4. The registered office in Virginia is
______________________________________________________ VA ___________________
(number/street)
(city or town)
(zip)
located in the [ ] city or [ ] county of _____________________________________.
5. A. The registered agent's name is _________________________________________________
whose business office is identical with the registered office.
B. The registered agent is (mark appropriate box)
(1) an INDIVIDUAL who is a resident of Virginia and
[ ] a member/manager of the limited liability company
[ ] an officer/director of a corporate member/manager of the limited liability company
[ ] a general partner of a general or limited partnership member/manager of the limited liability
company
[ ] a trustee of a trust that is a member of the limited liability company
[ ] a member of the Virginia State Bar
OR
(2)[ ] a professional corporation, professional limited liability company or registered limited liability
partnership registered with the Virginia State Bar under § 54.1-3902 of the Code of Virginia.
C. The registered office/agent comply with the requirements of § 13.1-1015 of the Code of Virginia.
6. The foreign limited liability company hereby irrevocably appoints the Clerk of the Commission as
the registered agent of the limited liability company for service of process if no registered agent
has been appointed under § 13.1-1015 of the Code of Virginia or, if appointed, the registered
agent's authority has been revoked or if the registered agent either has resigned or cannot be
found or served with the exercise of reasonable diligence.
[OVER]