Form Llf-2 - Application For Exemption From Certificate Of Authority Of A Limited Liability Company

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.
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Natalie E. Tennant
Penney Barker, Manager
Secretary of State
Corporations Division
1900 Kanawha Blvd E
Tel: (304)558-8000
Bldg 1, Suite 157-K
Fax: (304)558-8381
Charleston, WV 25305
Website:
E-mail:
APPLICATION FOR EXEMPTION FROM
FILE ONE ORIGINAL
Office Hrs: Monday – Friday
CERTIFICATE OF AUTHORITY OF A
8:30 a.m. – 5:00 p.m. ET
(Two if you want a filed
LIMITED LIABILITY COMPANY
stamped copy returned to you)
FEE: $25.00
Control #______________
Organization Information
1. The name of the limited liability co. 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 organization is:
__________________________________________ __________________________________________
No. & Street
City/State/Zip
Business/Employees in WV:
4. The type of business to be conducted in WV is: _______________________________________________
5. Are on site contractual services provided to another business located in WV? If yes, please describe:
_____________________________________________________________________________________
6.
Will you maintain an office in WV? If yes, where?
No
Yes, at:_______________
7.
Will you apply for a contractor’s license for construction work?
No
Yes
8.
Is the business in the state limited to sales? If yes, answer a-d
No
Yes
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?
Common Carrier
Co. Vehicles
9. Do you expect work to be limited to only one occasion of no
No, we plan on multiple jobs or on-
more than one month?
going business
_______
______
Yes, Beginning
Ending:
10. Will you have employees, other than sales people working
No
Yes
within the state? 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 Workers’ Comp. Coverage?
No
Yes
Basis for Claiming Exemption:
11. List section number of the WV Code
§31B-10-1003
which makes your business exempt from being required to
have a certificate of authority. List the section number (see attached list) in the blank space provided below.
Code Number: (A) _______
12. Print name of signer: __________________________________ Title/Capacity: _____________________
Signature: ___________________________________________ Date: __________________________
_
Form LLF-2
Issued by the Office of the Secretary of State
Revised 4/13

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