Form 241 - Application For Certificate Of Authority For Foreign Limited Liability Company

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OFFICE OF SECRETARY OF STATE
CORPORATIONS DIVISION
237 Coliseum Drive
Macon, Georgia 31217
(404) 656-2817
Registered agent, officer, entity status information via the Internet
sos.georgia.gov/corporations
Brian P. Kemp
Secretary of State
APPLICATION FOR CERTIFICATE OF AUTHORITY
FOR FOREIGN LIMITED LIABILITY COMPANY
IMPORTANT
Remember to include your e-mail address when completing this transmittal form.
Providing your e-mail address allows us to notify you via e-mail when we receive your filing and when we take
action on your filing. Please enter your e-mail address on the line below. Thank you.
E-Mail: _____________________________________________________________________
N O T I C E T O AP P L I C AN T : P R I N T P L AI N L Y O R T Y P E R E M AI N D E R O F T H I S F O R M
1.
Limited Liability Company Name
Name Reservation Number (Optional)
Date Business Commenced (Or Proposed) in Georgia
(NOTE: If the date provided here is more than 30 days prior to the date the application is
received by the Secretary of State, a $500 penalty must be paid; penalty is statutory and cannot be waived by Secretary of State.)
2.
Name of filing person (certificate will be mailed to this person, at address below)
Telephone Number
Address
City
State
Zip Code
3.
Jurisdiction (Home state/country)
Date of Organization in home state
4.
Address of Principal Place of Business
City
State
Zip Code
5.
Name of Registered Agent in Georgia
Registered Office Street Address in Georgia (Post office box or mail drop not acceptable for registered office address)
GA
City
County
State
Zip Code
6.
Manager’s Name & Address (Person w/responsibility for maintaining records)
City
State
Zip Code
7.
Address Where Limited Liability Company Records Are Maintained
City
State
Zip Code
8.
NOTICE: Mail or deliver an original and one copy of this form and the filing fee of $225.00 to the Secretary of State at the above address.
Filing fees are NON-refundable.
This application is signed by a person duly authorized to sign such instruments by the laws of the jurisdiction under which the foreign
limited liability company is organized. The foreign limited liability company undertakes to keep its records at the address shown in #7
above until its registration in Georgia is canceled or withdrawn. The foreign limited liability company, in accordance with Title 14 of the
Official Code of Georgia Annotated, appoints the Secretary of State as agent for service of process if no agent has been appointed in
Georgia or, if appointed, the agent’s authority has been revoked or the agent cannot be found or served by the exercise of reasonable
diligence.
Authorized Signature
Date
Request certificates and obtain entity information via the Internet:
FORM 241

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