JAY DARDENNE SECRETARY OF STATE
STATE OF LOUISIANA SECRETARY OF STATE
Commercial (225) 925-4704 (225) 922-0435 Fax Administrative Services (225) 925-4704 (225) 925-4726 Fax Uniform Commercial Code (225) 922-1193 (225) 922-0452 Fax
TRANSMITTAL INFORMATION For All Business Filings
Business Name (List exactly as it appears in documents)
Name of person filing document (evidence of filing will be mailed to this person, at address below)
Address
City
State
Zip Code
Daytime phone number
Fax number
Email address
NOTE: Louisiana Law requires all Louisiana notaries to print or type their name and notary or bar roll number on the document.
Mailing Address: P. O. Box 94125, Baton Rouge, LA * 70804-9125 Office Location: 8585 Archives Ave., Baton Rouge, LA * 70809 Web Site Address: www.sos.louisiana.gov
SS984 Rev. 10/08
STATE OF LOUISIANA SECRETARY OF S TATE
JAY DARDENNE SECRETARY OF STATE
Commercial (225) 925-4704 Fax (225) 922-0435 Administrative Services (225) 925-4704 Fax (225) 925-4726 Uniform Commercial Code (225) 922-1193 Fax (225) 922-0452 First Stop Shop (225) 922-2895 Fax (225) 925-4591
IMPORTANT NOTICE The instructions from the Secretary of State's office in order to qualify a foreign limited liability company to do buiness in the state of Louisiana are the following: 1. The name must be identical to the name on certificate of existence or good standing from organizing jurisdiction. The certificate must be dated within (90) ninety days of its submission. (In the states of Texas and Alabama, obtain a certificate of existence from the Secretary of State, not a good standing from the Comptroller/Department of Revenue.) The name must be identical to the name on the certificate of fact evidencing the name change issued by the proper official of the organizing jurisdiction. The date organized in your state or country and period of duration, if any. The street address of the principal office of the organization in the state or country under the laws of which it is organized. The street address or intended street address of its principal business office outside the state of Louisiana. If you do not have one, write none in this space. The address of the principal business establishment in this state. This address shall be the street address of your registered agent if the agent is an individual or corporation. The agent must be an individual resident in Louisiana, an individual attorney or a partnership which is authorized to practice law in Louisiana or a domestic or foreign corporation authorized to act as registered agent for other organizations. The nature of business that the limited liability company proposes to transact in this state and a statement that it is empowered to transact such business under the laws under which it is organized. NOTE: If the company includes in its name the words "engineer", "engineering", "surveyor", or "surveying", please contact the Louisiana Professional Engineering and Land Surveying Board prior to submitting the application for authority. They can be contacted at (225) 925-6291, 9643 Brookline Ave., Suite 121, Baton Rouge, LA 70809 (www.lapels.com).
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Mailing Address: P. O. Box 94125, Baton Rouge, LA * 70804-9125 Office Location: 8585 Archives Ave., Baton Rouge, LA * 70809 SS971 Rev. 2/07 Web Site Address: www.sos.louisiana.gov
Jay Dardenne Secretary of State
APPLICATION FOR AUTHORITY TO TRANSACT BUSINESS IN LOUISIANA
(R.S. 12:1345) Foreign Limited Liability Company Return to: Commercial Division Enclose $125.00 filing fee P. O. Box 94125 Make remittance payable to Baton Rouge, LA 70804-9125 Secretary of State Phone (225) 925-4704 Do Not Send Cash Web site: www.sos.louisiana.gov
STATE OF PARISH/COUNTY OF
Check one: ( ) ( )
Original Application Amended Application
1. Limited liability company name: 2. Previous company name: 3. Date of organization: 4. Principal office address in state or country of organization: Period of duration:
5. Principal business office address:
PLEASE INCLUDE COMPLETE STREET ADDRESSES FOR THE FOLLOWING. 6. Principal business establishment in Louisiana:
7. Registered office address in Louisiana:
8. Registered agent's name and address in Louisiana:
9. Nature of business to be transacted in Louisiana:
To be signed by a Member/Manager
Title and Date
Sworn to and subscribed before me, the undersigned Notary Public, on this date:
Notary
AGENT'S ACCEPTANCE AND ACKNOWLEDGEMENT OF APPOINTMENT I hereby acknowledge and accept the appointment of registered agent for and on behalf of the above named limited liability company.
Registered Agent
Sworn to and subscribed before me on this date:
Notary
SS972 Rev. 03/08