Application For Registration Foreign Limited Liability Company - Office Of The Secretary Of The State O Connecticut

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APPLICATION FOR REGISTRATION
FOREIGN LIMITED LIABILITY COMPANY
Office of the Secretary of the State
30 Trinity Street / P.O. Box 150470 / Hartford, CT 06115-0470 / Rev. 10/01/2004
See reverse for instructions
Space For Office Use Only
Filing Fee: $60.00
Please contact the Department of Revenue Services or your tax advisor as to any potential tax liability relating to your
business.
1. NAME OF LIMITED LIABILITY COMPANY IN STATE OR COUNTRY OF FORMATION
2. NAME UNDER WHICH THE LIMITED LIABILITY COMPANY WILL TRANSACT BUSINESS IN
CONNECTICUT, IF DIFFERENT FROM NAME STATED ABOVE
3. STATE/COUNTRY OF FORMATION
4. DATE OF FORMATION
5. DATE LIMITED LIABILITY COMPANY
BEGAN TRANSACTING BUSINESS IN CONNECTICUT _______/_______/________
Month
Day
Year
6. ADDRESS REQUIRED TO BE MAINTAINED IN PLACE OF FORMATION OR, IF NOT REQUIRED, THE PRINCIPAL
OFFICE ADDRESS OF THE LIMITED LIABILITY COMPANY
7. CHARACTER OF BUSINESS TO BE TRANSACTED IN CONNECTICUT
8. APPOINTMENT OF REGISTERED AGENT FOR SERVICE OF PROCESS
(Check A or complete B)
The limited liability company appoints the Secretary of the State of Connecticut and his successors in office
A. ________
To be its agent upon whom any process, in any action or proceeding against it, may be served.
B. Print or type Name of Agent
Business address (P.O. Box is unacceptable)
______________________________________
Acceptance of Appointment
Residence address (P.O. Box is unacceptable)
________________________________
Signature of Agent
9. MANAGER(S) OR MEMBER(S) INFORMATION
Name
Title
Residence Address
Business Address
10. EXECUTION
Dated this _____ day of _________, 20________.
The undersigned asserts that the subject limited liability company is a foreign limited liability company as defined in
Connecticut General Statute Section 34-101(8).
Print or type Name of Signatory
Capacity of Signatory
Signature
Reference an 8 ½ x 11 attachment if additional space is required

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