Limited Liability Company Initial Report {973}

LIMITED LIABILITY COMPANY INITIAL REPORT(R.S. 12:1305 (E)) Secretary of State The name of this limited liability company is: The location and municipal address, not a post office box only, of this limited liability company222sregistered office: 3.The full name and municipal address, not a post office box only, of each of this limited liability company222sregistered agent(s) is/are:4.The names and municipal addresses, not a post office box only, of the first managers, or the members: To be signed by each person who signed the articles of organization: AGENT222S AFFIDAVIT AND ACKNOWLEDGEMENT OF ACCEPTANCEI hereby acknowledge and accept the appointment of registered agent for and on behalf of the abovenamed limited liability company. Registered agent(s) signature(s):Sworn to and subscribed before me, the undersigned Notary Public, on this date: Notary Signature SS973 Rev. 0 (see instructions on back) NOTARY NAME MUST BE TYPED OR PRINTED WITH NOTARY # INSTRUCTIONS An Initial Report must be completed and filed with the Articles of Organization of a Limited Liability Company. The name shall contain the words limited liability company the abbreviation 223L.L.C.224or the abbreviation 223L.C.224If no first managers or members have been selected when the Initial Report and Articles of Organization are filed, a Supplemental Report, setting forth their names and addresses must be filed in accordance with R.S. 12:1305 (E)4.The Affidavit of Acknowledgement and Acceptance contained on the bottom of this form must be signed by each registered agent before a notary public. www.FormsWorkflow.com