Form Lcf 1-1.0 - Application For Registration Llc Page 3
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4INSTRUCTIONS
1. Name of limited liability company in state or country of formation-REQUIRED: Please provide the name of the limited
liability company.
2. Name under which the limited liability company shall transact business in Connecticut: If the limited liability company
shall transact business in Connecticut under a name other than its name in its state of formation, set forth such name
in the space provided. The name must be distinguishable from all other business names of record in the Office of the
Secretary of the State and contain an appropriate limited liability company designation such as LLC.
3. State or country of formation-REQUIRED: Please provide the limited liability company's state or country of formation.
4. Date of formation-REQUIRED: Please provide the date upon which the limited liability company was formed in its
state or country of formation. The date must include a month, day and year.
5. Date limited liability company began transacting or will begin transacting business in Connecticut-REQUIRED: Please
provide the exact month, day and year upon which the limited liability company began transacting business in
Connecticut. If the limited liability company has not yet commenced transacting business in Connecticut, please make
a statement to that effect.
6. Office address of the limited liability company-REQUIRED: Please provide the complete office address that is
required to be maintained in the state or country of the limited liability company’s formation. If not so required, please
provide its principal office address. All addresses must include a street number, street name, city, state, postal code
and country if other than the United States. Note that P.O. boxes are only acceptable as additional information.
7. Character of business to be transacted in Connecticut Please provide a description of the business which the limited
liability company will transact in Connecticut.-REQUIRED.
8. Appointment of registered agent-REQUIRED: The limited liability company may appoint either:
A. The Secretary of the State
or
B. Any individual who is a resident of Connecticut, including a manager or member of the LLC. (An individual
must provide the complete street address of his or her business and a Connecticut residence address.)
or
Any of the following business types, on record with this office:
• A Connecticut corporation, limited liability company, limited liability partnership or statutory trust
• A foreign corporation, limited liability company, limited liability partnership or statutory trust, which has obtained a
certificate of authority to transact business in Connecticut and has a Connecticut address on file with this office
1. The business must provide a Connecticut business address in Box 8B.
2. Print the name & title under the signature of the individual signing acceptance on behalf of the business agent.
9. Manager(s) or member(s) information-REQUIRED: The Limited Liability Company must list the name, title, residence
and business address of one manager or member of the Limited Liability Company. More than one may be listed
(attach extra sheet if necessary).
10. Execution: The document must be executed by an authorized official of the limited liability company.
That person must print or type his or her full legal name, state the capacity/title under which he/she signs and provide
his/her signature. The execution constitutes a legal statement under the penalties of false statement that the
information provided in the document is true.
FORM LCF-1-1.0
DO NOT SCAN THIS PAGE
INSTRUCTIONS
Rev. 2/2011
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