Application For Certificate Of Authority Limited Liability Company (Page 5 of 6) in pdf

Application For Certificate Of Authority Limited Liability Company Page 5

APPLICATION FOR CERTIFICATE OF AUTHORITY

LIMITED LIABILITY COMPANY

(ss-4233)

Page 1 of 2

For Office Use Only

Business Services Division

Tre Hargett, Secretary of State

State of Tennessee

312 Rosa L. Parks AVE, 6th Fl.

Nashville, TN 37243-1102

(615) 741-2286

Filing Fee: $50.00 per member

(minimum fee = $300, maximum fee = $3,000)

To The Secretary of the State of Tennessee:

Pursuant to the provisions of T.C.A. §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 foreign Limited Liability Company

if its name does not comply with the requirements of T.C.A. §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 T.C.A.

§48-249-106(d).

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

and the date of its formation is:

and the date it commenced doing business in Tennessee is:

Month

Day

Year

Month

Day

Year

NOTE: Additional filing fees and proof of tax clearance confirming good standing may apply if the Limited Liability Company

commenced doing business in Tennessee prior to the approval of this application. See T.C.A. §48-249-913(d) and T.C.A.

§48-249-905(c)

3. This company has the additional designation of:

4. The name and complete address of its registered agent and office located in the state of Tennessee is:

Name:

Address:

City:

State:

Zip Code:

County:

5. Fiscal Year Close Month:

6. If the document is not to be effective upon filing by the Secretary of State, the delayed effective date and time is:

(Not to exceed 90 days)

Effective Date:

Time:

Month

Day

Year

7. The LLC will be:

Member Managed

Manager Managed

Director Managed

Board Managed

Other

8. Number of Members at the date of filing:

9. Period of Duration:

Perpetual

Other

Month

Day

Year

10. The complete address of its principal executive office is:

Address:

City:

State:

Zip Code:

Rev. 10/12

RDA 2458

Application For Certificate Of Authority Limited Liability Company Page 5

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