Foreign Professional Limited Liability Company Application For Registration

STATE OF ALABAMA FOREIGN PROFESSIONAL LIMITED LIABILITY COMPANY (PLLC) APPLICATION FOR REGISTRATION Foreign PLLC - 1/2019 Page 1 of 2 PURPOSE: In order to register a foreign professional entity (any entity formed outside of Alabama) to transact business in Alabama, the entity must deliver to the Secretary of State for filing an Application for Registration pursuant to Section 10A-1-7.04, Code of Alabama 1975. INSTRUCTIONS: Mail two (2) completed forms with the appropriate fee to the Office of the Secretary of State at P O Box 5616, Montgomery, AL 36103. Include a check, money order, or credit card payment for $150.00 for standard processing or $250.00 for expedited processing (within twenty four (24) hours after date of receipt). The application is only accepted via mail or courier and will not be accepted via email. No fees are charged or deposited until the Application is approved. The entity will not be registered if the credit card does not authorize and will be removed from the index if the check is dishonored ($30 fee). All processing instructions are complete in this form and Payment Option Sheet; cover letters are not necessary and will not be reviewed. This form must be typed or laser printed. 1.The legal name of the foreign entity as recorded in the jurisdiction in which it was formed/organized: 2.The name of the foreign entity for use in Alabama must contain the words 223Professional Limited LiabilityCompany224 or the abbreviation 223P.L.L.C.224 or 223PLLC224: *A fictitious name may be used only if the legal entity name is not available for use in Alabama or the name does not contain the words 223Professional Limited Liability Company224 or the abbreviation 223P.L.L.C.224 or 223PLLC224 (10A-1-5.06). 3.If a fictitious name is used the undersigned certifies the resolution of the PLLC222s governing authority to adoptthe fictitious name for use in Alabama and affirms the authority to make such a certification under 10A-1-7.07 4.A copy of the name reservation received from the Office of the Alabama Secretary of State must be attached. 5.Street (No PO Boxes) Address of principal office: Mailing Address (if different from street address) 6.Entity222s jurisdiction of formation: (State or Country, if formed outside the United States, of formation) 7.Date of the entity222s formation in state/country of jurisdiction:/ / (MM/DD/YYYY) (For SOS Office Use Only) American LegalNet, Inc. www.FormsWorkFlow.com FOREIGN PROFESSIONAL LIMITED LIABILITY COMPANY (PLLC) APPLICATION FOR REGISTRATION Foreign PLLC - 1/2019 Page 2 of 2 8.The undersigned certifies that the foreign entity exists as a valid Professional Limited Liability Company under thelaws of the entity222s jurisdiction of formation 9.Name of registered agent for service of process (MUST be physically located in Alabama): 10.Street (No PO Boxes) Address of initial registered office (MUST be office of registered agent and physically located in Alabama): Mailing Address in Alabama of registered agent/office (if different from street address) 11.The entity designates the following Alabama licensed individual or individuals through whom it will renderprofessional services in Alabama and certifies that those individuals are not, at the time of designation, sodesignated by any other foreign professional entity (names, mailing addresses, and evidence of licenses): Attach copies or additional pages if necessary. 12.The entity acknowledges that it will be subject to the jurisdiction of the Alabama regulatory and licensingauthorities with respect to any professional services rendered to clients or patients in Alabama. 13.No foreign professional entity shall maintain an office in Alabama for the conduct of business or professionalpractice until it has obtained a certificate of authority to render professional services in Alabama: Certificate attached or Not Applicable 14.If the entity registering is a Non Profit LLC, Series LLC or Non-Profit Series LLC. Please check type below: Non-Profit PLLC Series PLLC Non-Profit Series PLLC 15.The foreign entity will begin or began transacting business in Alabama (a date must be provided): Began or Will begin doing business: / / (MM/DD/YYYY) Date (MM/DD/YYYY) Typed Name and Title of Signature Below Signature of Person Authorized to Sign per 10A-1-4.01, Alabama Code In order to review the sections of the Code of Alabama 1975 referred to in this filing form you may access www.sos.alabama.gov and Go to Records. Choose the Code of Alabama link to review. American LegalNet, Inc. www.FormsWorkFlow.com Foreign Prof. LLC Registration Payment Sheet Secretary of State Payment Option Sheet: If you do not send an acknowledgement copy and a pre- addressed postage paid envelope with the filling, you will not receive a credit card or prepaid account receipt from the Secretary of State222s Office. Hold for pickup request 226 acknowledgement copy will have the receipt attached. The document of record will be stamped showing the receipt of the filing fee and expedite fee but will not show convenience fees which will be charged; (generally these fees are between 2% and 5% of the total charge). Information MUST be typed or laser printed on a computer. Entity Name: Service Requested: $150.00 Registration filing fee $100.00 Expedited Processing fee (Processed within 24hours after receipt of filing) Hold at Front Desk for Pick-up for: (Service providers who run couriers for pick-up 226 we do not have a call for pick-up service) Check is attached - Please make one check payable for the total amount of the fees (i.e., $250. if you are requesting expedited service) to the Alabama Secretary of State. Charge fees to prepaid account: Account Number and Account Name Typed Name & Signature of Authorized Individual on Account Credit Card Type: (Visa, MC, Discover & AmEx) Card Number: Expiration Mo/Yr: / (MM/YY) Card Holder Name: Complete Billing Address: Street or PO City State Zip Signature of Card Holder: MUST be Signature of Card Holder American LegalNet, Inc. www.FormsWorkFlow.com