Mississippi Llc Certificate Of Formation
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211 F0100
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OFFICE OF THE SECRETARY OF STATE
P O BOX 1020, JACKSON, MS 39215-1020 (601)359-1633
Mississippi LLC Certificate of Formation
The undersigned hereby executes the following document and sets forth:
(fields marked with an asterisks are required)
1. Name of the Limited Liability Company: (The name must include the words “Limited Liability Company” or the
abbreviation “LLC” or “L.L.C.”)
*
_______________________________________________________________________________________________
2. The future effective date is
(Complete if Applicable)
__________________
Business Email Address:_______________________________
3. Federal Tax ID if available (Do not put Social Security Number in the box)
_______________________________________________________________________________________________
4. Name and Street Address of the Registered Agent and Registered Office is (must be in Mississippi)
*Name
_____________________________________________________________________________________
*Physical
Address
_____________________________________________________________________________________
P.O. Box
______________________________________________________________________________________
*City
______________________________________
*
State_______
*
Zip5 – Zip4 ______________________
5. If the Limited Liability Company is to have a specific date of dissolution, the latest date upon which the Limited
Liability Company is to dissolve is
_______________________________________________________________________________________________
6. Other matters the managers or members elect to include: (Attach additional pages if necessary)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Rev. 06/2012
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