NOTE: if changing the name or jurisdiction, you must attach a recent dated state certified copy of the
applicable amendment.
______________________________________________________________________________
Name of limited liability company
_____________________________________________________________________________
By: __________________________________________________________________________
Its: __________________________________________________________________________
(Authorized Manager or Member)
MAIL TO:
DEPARTMENT OF CONSUMER AND REGULATORY AFFAIRS
ONE STOP BUSINESS CENTER
941 NORTH CAPITOL STREET, N.E., ROOM #1100
WASHINGTON, D.C. 20002
FEES DUE
Filing Fee ....$100
Make Check Payable to D.C. Treasurer