Form Ss-4233 - Application For Certificate Of Authority (Limited Liability Company) printable pdf download

For Ofﬁce Use Only

APPLICATION FOR

CERTIFICATE OF AUTHORITY

Corporate Filings

(Limited Liability Company)

312 Eighth Avenue North

Floor, William R. Snodgrass Tower

Nashville, TN 37243

To the Secretary of State of the State of Tennessee:

Pursuant to the provisions of §48-249-904 of the Tennessee Revised Limited Liability Company Act, the undersigned

hereby applies for a certiﬁcate of authority to transact business in the State of Tennessee, and for that purpose sets forth:

1. The name of the Limited Liability Company is: __________________________________________________________

If diﬀerent, the name under which the certiﬁcate of authority is to be obtained is:_________________________________

____________________________________________________________________________________________________

NOTE: The Secretary of State of the State of Tennessee may not issue a certiﬁcate of authority to a for-

eign Limited Liability Company if its name does not comply with the requirements of § 48-249-106

of the Tennessee Revised Limited Liability Company Act. If obtaining a certiﬁcate of authority

under an assumed Limited Liability Company name, an application must be ﬁled pursuant to § 48-

249-106(d).

2. The state or country under whose law it is formed is: _____________________________________________________

and its date of its formation is: __________________________________ (must be month, day and year)

3. The complete street address (including zip code) of its principal executive oﬃce is:

Street

City/State

Zip Code

4. The complete street address (including the county and the zip code) of its registered oﬃce in Tennessee:

Street

City/State

County

Zip Code

The name of its registered agent at that oﬃce is: ____________________________________________________________

5. If the provisions of TCA §48-249-309(i) (relating to foreign series LLCs) apply, then the information required by that

section should be attached as part of this document.

6. The number of members at the date of ﬁling if more than six (6): ______________________

7. If the limited liability company commenced doing business in Tennessee prior to the approval of this application, the

date of commencement (month, day and year) _____________________.

NOTE:

This application must be accompanied by a certiﬁcate of existence or a document of similar import (for example,

a certiﬁcate of good standing) duly authenticated by the Secretary of State or other ofﬁcial having custody of

the Limited Liability Company records in the state or country under whose law it is organized. The certiﬁcate

shall not bear a date of more than two (2) months prior to the date the application is ﬁled in this state.

Signature Date

Name of Limited Liability Company

Signer’s Capacity

Signature

Name (typed or printed)

SS-4233 (Rev. 01/06)

RDA 2458

Filing Fee: $50 per member / minimum fee=$300, maximum fee=$3,000

Form Ss-4233 - Application For Certificate Of Authority (Limited Liability Company)

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