Form Sfn 19381 - Certificate Of Authority Application Foreign Limited Liability Company

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COMPLETE, PRINT, SIGN, AND MAIL OR FAX (If paying by credit card, complete Credit Card Payment Authorization on page 3)
For Office Use Only
CERTIFICATE OF AUTHORITY APPLICATION
ID Number:
FOREIGN LIMITED LIABILITY COMPANY
SECRETARY OF STATE
WO Number:
SFN 19381 (09-2015)
Filed:
By:
SEE INSTRUCTIONS FOR FEE, FILING AND MAILING INFORMATION
TYPE OR PRINT LEGIBLY
For reference, see North Dakota Century Code, Sections 10-31-01, 10-31-13.1 and 10-32.1-75
1. The application is accompanied by the following:
Certificate of professional license
*Filing fee of $135
*Current CERTIFICATE OF GOOD STANDING or
Signed Consent to Use Business Name and fee of $10
CERTIFICATE OF EXISTENCE duly authenticated by the
organizing officer of the state or country of organization
Trade Name Registration and fee of $25
2. Type of limited liability company applying for certificate of authority (check one)
3. Federal ID Number
Foreign Professional
Foreign Business
4. Name of limited liability company EXACTLY as it appears on Certificate of Good Standing from state or country of origin
5. If applicable, provide the trade name and complete the Trade Name Registration form if selected trade name is not already registered in North Dakota.
Only provide the trade name in this line if:
a)
The "new" limited liability company name is not in the form as required of limited liability companies in North Dakota.
b)
The Secretary of State has notified the limited liability company that its "new" name is the same or deceptively similar to a name already
registered, and the limited liability company is unable to obtain Consent to Use Business Name from the previous filer or a certified copy of a final
decree of a court of competent jurisdiction establishing prior right of this limited liability company to use of the name in North Dakota.
c)
The limited liability company does not wish to use or protect its "new" name in North Dakota and chooses to use a name other than its limited
liability company name.
6. Complete address of principal executive office (Street/RR, PO Box, City, State, ZIP+4) Street address MUST be provided; may not be only a post
office box.
8. Limited liability company will expire in state or country of origin (check one)
7. State or Country Where Organized
Perpetual
Expires - Specify date:
9. Telephone Number
10. Toll Free Telephone Number
11A. Name of commercial registered agent in North Dakota
11B. Name of noncommercial registered agent in North Dakota
OR
11C. Address of noncommercial registered agent in North Dakota (Street/RR, PO Box, City, State, ZIP+4) Street address MUST be provided; may
not be only a post office box.
12. Nature of business or activities the limited liability company conducts or intends to conduct in North Dakota
13. Managers and governors of the limited liability company (attach additional sheet, if necessary)
Manager
also serves
COMPLETE MAILING ADDRESS
as Governor
MANAGERS
Street/Rural Route
Post Office Box
City
State
ZIP+4
Managing Member
Managing Member
14. "The undersigned has read the foregoing application, knows the contents, and believes the statements to be true. I further authorize the Secretary of
State to correct numbers 4, 7, 11A, 11B, and 11C if not correctly reflected. I understand that if I make a false statement in this document, I may be subject to
criminal penalties."
Signature
Date
15. Name of Person to Contact About This Document
Email Address
Daytime Telephone Number

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