Form Foreignllcreg1999.01 - Application For Registration Of Foreign Limited-Liability Company

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Office Use Only:
DEAN HELLER
Application for
Secretary of State
Registration of Foreign
Limited-Liability Company
101 North Carson Street, Suite 3
Carson City, Nevada 89701-4786
(PURSUANT TO NRS 86.551)
(
775) 684 5708
Important: Read attached instructions before completing form.
1.
Name of Foreign
Limited-Liability
Company:
2.
Name Being
Registered
with Nevada:
(name under which this
foreign limited- liability
company proposes to
register and transact
business in Nevada)
3.
Date of Formation
and State or
Country in which
Company was
_________________________
_____________________________________
formed:
Date Formed
State or Country where authorized
4.
Resident Agent
Name and Street
________________________________________________________________________________
Address:
Name
(must be a Nevada address
where process may be
__________________________________________________________, NEVADA ____________
served)
Street Address
City
Zip Code
In the event the above-designated Agent for Service of Process resigns and is not replaced or the agent’s authority has
been revoked or the agent cannot be found or served with exercise of reasonable diligence, then the Secretary of State
is hereby appointed as the Agent for Service of Process.
5.
Street Address of
Principal Office:
(or office required to be
__________________________________________________________, ________ ____________
maintained int the domicile
state by the laws of that
Street Address
City
State
Zip Code
state)
6.
Names and
1._______________________________________________________________________________
Addresses of each
Name
Member:
__________________________________________________________, ________ ____________
(attach additional pages if
there are more than 2
Street Address
City
State
Zip Code
members)
2._______________________________________________________________________________
Name
__________________________________________________________, ________ ____________
Street Address
City
State
Zip Code
7.
Name and
Signature
_____________________________________
_______________________________________
of Member making
Name
Signature
Statement:
I hereby declare and verify that I am a member of the above named Limited-Liability Company and that I have executed
this application for registration.
8. Certificate of
Acceptance of
I, _____________________________________________hereby accept appointment as Resident Agent for the above
Appointment of
named Foreign Limited-Liability Company.
Resident Agent:
____________________________________________________
______________________________________
Signature of Resident Agent
Date
This form must be accompanied by appropriate fees. See attached fee schedule.
Nevada Secretary of State Form FOREIGNLLCREG1999.01
Revised on: 03/08/00

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