Form Llf-2 - Application For Exemption From Certificate Of Authority Of Limited Liability Company For West Virginia
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1
2Natalie E. Tennant
Penney Barker, Manager
Secretary of State
Corporations Division
State Capital Bldg.
Tel. (304)558-8000/Fax: (304)5588381
1900 Kanawha Blvd. East
Hrs. 8:30am – 5:00pm ET
Charleston, WV 25305
APPLICATION FOR EXEMPTION
FILE ONE ORIGINAL
FROM CERTIFICATE OF
FILING FEE IS $25
(Send two originals if you want a
AUTHORITY OF LIMITED LIABILITY
filed copy returned to you)
COMPANY FOR WEST VIRGINIA
Organization Information
1.
The name of the Limited Liability Company applying to do business in WV:________________________________________
2.
The company was organized under the laws of the State of: __________________ Date of organization:__________________
3.
The address of the principal office of the Limited Liability Company is:
_________________________________________
_____________________________________________________________
No. & Street
City, State and Zip
4.
Name and phone number of person to contact if there is a problem with the filing in order to avoid having to return or reject the
document. (optional)
__________________________________________________
_____________________________________________________
Contact Name
Phone Number
Business/Employees in WV:
1.
The type of business to be conducted in WV is:______________________________________________________________
2.
Are on site contractual services provided to another business located in WV? If yes, please describe:
____________________________________________________________________________________________________
3.
Will you maintain an office in WV? If yes, where?
No
Yes, at:_______________
4.
Will you apply for a contractor’s license for construction work?
No
Yes
5.
Is the business in the state limited to sales? If yes, answer a-d
No
Yes, sales only
a. Does any salesperson reside in the state?
No
Yes
b. Will any salesperson need WV Workers’ Comp. coverage?
No
Yes
c. Does your salesperson have authority to finalize a contract?
No
Yes
d. How are goods shipped to your customers?
No
Yes
6.
Do you expect work to be limited to only one occasion of no
more than one month?
No, we plan multiple jobs or on going business
Yes, beginning ______________ ending:______________
7.
Will you have employees, other than sales people
No
Yes on contract
Working within the state?
to another co.
If yes, answer a-c
a.
Will WV taxes be withheld?
No
Yes
b. Will they have WV Unemployment coverage
No
Yes
c.
Will they have WV Worker’s Comp. coverage?
No
Yes
Basis for Claiming Exemption:
List section number(s) of the W. Va. Code §31B-10-1003 which makes your business
exempt from being required to have a certificate of authority:___________
Certification: I certify the above information is true and that I am authorized to act on behalf of the organization.
Print Name of Signer: ___________________________________ Title/Capacity of Signer: ________________________________
Signature: _______________________________________________
Date:____________________________________________
Business email address, if any: ____________________________________________________________________________________________________________
Form LLF-2
Issued by the Secretary of State, State Capitol, Charleston, WV 25305
Revised 1/09
RESET
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