Certificate Of Formation Professional Llc Page 7

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Organizer
The name and address of the organizer:
Name
Street or Mailing Address
City
State
Zip Code
Effectiveness of Filing
(Select either A, B, or C.)
A.
This document becomes effective when the document is filed by the secretary of state.
B.
This document becomes effective at a later date, which is not more than ninety (90) days from
the date of signing. The delayed effective date is:
C.
This document takes effect upon the occurrence of the future event or fact, other than the
th
passage of time. The 90
day after the date of signing is:
The following event or fact will cause the document to take effect in the manner described below:
Execution
The undersigned affirms that the person designated as registered agent has consented to the
appointment. The undersigned signs this document subject to the penalties imposed by law for the
submission of a materially false or fraudulent instrument and certifies under penalty of perjury that the
undersigned is authorized to execute the filing instrument.
Date:
Signature of organizer
Printed or typed name of organizer
Print
Reset
Form 206
7

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