W. Fox McKeithen
Secretary of State
LIMITED LIABILITY COMPANY INITIAL REPORT
(R.S. 12:1305 (E))
1. The name of this limited liability company is: _______________________________________________
2. The location and municipal address, not a post office box only, of this limited liability company's registered
office:
__________________________________________________________________________________
3. The full name and municipal address, not a post office box only, of each of this limited liability company's
registered agent(s) is/are:
__________________________________________________________________________________
__________________________________________________________________________________
4. The names and municipal addresses, not a post office box only, of the first managers, or the members:
__________________________________________________________________________________
__________________________________________________________________________________
To be signed by each person who signed the articles of organization:
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
AGENT'S AFFIDAVIT AND ACKNOWLEDGEMENT OF ACCEPTANCE
I hereby acknowledge and accept the appointment of registered agent for and on behalf of the above named
limited liability company.
Registered agent(s) signature(s):
___________________________________________
___________________________________________
Sworn to and subscribed before me this _______________ day of _____________________, 19_______.
_________________________________________
Notary
973 5/97
(See instructions on back)