Free 49464.FH11 - Indiana

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APPLICATION FOR CERTIFICATE OF AUTHORITY OF A FOREIGN LIMITED LIABILITY COMPANY
State Form 49464 (R2 / 1-09) Approved by State Board of Accounts, 2007 Indiana Code 23-18-11-4 et seq.

TODD ROKITA SECRETARY OF STATE Mail to the following address: BUSINESS SERVICES DIVISION 302 W. Washington St., Room E018 Indianapolis, IN 46204 T elephone: (317) 232-6576 Filing Fee: $ 90.00 Make check or money order payable to Secretary of State

NOTES:

1. An Original Certificate of Existence duly authenticated by the proper authority from corporations domicilary state within the last sixty (60) days must be submitted with this application. 2. A Registered Agent with an Indiana street address (not a PO BOX) must be listed in ARTICLE II. 1. Use 8-1/2" x 11" white paper for attachments. 2. Present original and one (1) copy to the address on upper right corner of this form. 3. Please TYPE or PRINT. 4. Please visit our office on the web at www.sos.in.gov.

INSTRUCTIONS:

APPLICATION FOR CERTIFICATE OF AUTHORITY OF

A FOREIGN LLC TO TRANSACT BUSINESS IN THE STATE OF INDIANA The undersigned manager or member of the above ______________________________________________________________ LLC
(State of Domicile)

desiring to effectuate the admittance of the LLC to transact business in the State of Indiana, under the name of _________________________________________________________________________________ certifies the following facts:
(if using a fictitious business name, please specity the name above)

ARTICLE I: Name and Principal Office
Name of LLC (This must be identical to name shown in Articles of Organization and Amendments thereto.)

Address of the principal office of LLC (number and street, city, state, and ZIP code)

ARTICLE II: Registered Office and Registered Agent
Name of the registered agent of the LLC Indiana address of the registered office of LLC (number and street, city, state, and ZIP code)

ARTICLE III: Date of Organization and Duration of Existence
Date of organization in domicilary state (month, day, year) Expected period of duration listed in the Articles of Organization (month, day, year or perpetual)

ARTICLE IV: Management The Articles of Organization state that the LLC is to be managed by its members. The Articles of Organization provide for a manager or managers. In witness whereof, the undersigned being the___________________________________________________ of said LLC executes this
(Manager or member)

Application for Certificate of Authority, and verifies subject to penalties of perjury, that the facts contained herein are true this __________________day of __________________________ , 20_______.
Signature Printed name