Application For Certificate Of Authority {L-09}

BUSINESS REGISTRATION DIVISION P.O. BOX 29622 RALEIGH, NC 27626-0622 (Revised July 201 7 ) (Form L-09) Instructions for Filing APPLICATION FOR CERTIFICATE OF AUTHORITY FOR A LIMITED LIABILITY COMPANY (Form L - 09) Item 1 Enter the complete name of the limited liability company (LLC) exactly as it appears in the records of the appropriate official in the state or country of formation. If the name cannot be used in North Carolina, enter the name (including an applicable limited liability company ending) that it wishes to use in North Carolina. Item 2 Enter the state or country of formation. Item 3 Select and the county in which it is located. If mail is not delivered to the street address of the principal office or if you prefer to receive mail at a P.O. Box or Drawer, enter the complete mailing address of the principal office. Item 4 Enter the name of the registered agent. The registered agent must be a North Carolina resident, an existing do mestic business corporation, nonprofit corporation or limited liability company, or a foreign business corporation, nonprofit corporation or limited liability company authorized to transact business or conduct affairs in North Carolina. Item 5 Enter the co registered office address must be located in North Carolina. Item 6 if mail is not delivered to the street address above or if you prefer to receive mail at a P.O. Box or Drawer. Item 7 Enter the names, titles, and usual business address of the current principal company officials of the LLC. Item 8 Attach a current Certifi cate of Existence or document of similar import with filing. Item 9 If needed, a statement indicating a copy of the resolution of its managers adopting a fictitious name is attached. Item 1 0 The Department offers a free voluntary notification system for which you may choose to participate. If you would like to receive this free service, please provide a business e - mail address in the space provided. Your participation will not result in your e - mail address being viewable on our website. Participation w ill help us to prevent identity theft in the event an unauthorized person submits a fraudulent document for filing in the name of the business entity. Item 1 1 The document will be effective on the date and at the time of filing, unless a delayed date or an effective time (on the date of filing) is specified. If a delayed effective date is specified without a time, it will be effective at 11:59:59 p.m. A delayed effective date may be specified up to and including the 90 th day after the day of filing. Date and Execution Enter the date the document was executed. In the blanks provided enter: The name of the limited liability company as it appears in Item 1. The signature of the principal company official of the LLC executing the document. The name and title of the above - signed principal company official. Attention : Foreign Limited Liability Companies wishing to render a professional service as defined in N.C.G.S. 24755B - 2(6) shall contact the appropriate North Carolina licensing board to determine whet her compliance with additional licensing requirements may be mandated by law. Such limited liability companies should consult N.C.G.S. 24757D - 2 - 02 for further details. American LegalNet, Inc. www.FormsWorkFlow.com BUSINESS REGISTRATION DIVISION P.O. BOX 29622 RALEIGH, NC 27626-0622 (Revised July 201 7 ) (Form L-09) State of North Carolina Department of the Secretary of State APPLICATION FOR CERTIFICA TE OF AUTHORITY FOR LIMITED LIABILITY COMPANY Pursuant to 247 57 D - 7 - 0 3 of the General Statutes of North Carolina, the undersigned limited liability company hereby applies for a Certificate of Authority to transact business in the State of North Carolina, and for that purpose submits the following: 1.The name of the limite d liability company is ; and if the limited liability company name is unavailable for use in the State of North Carolina, the name the limited liability company wishes to use is . 2.The state or country under whose laws the limited liability company was formed is . 3 .Principal office information: ( Select either a or b.) a. The limited liability company has a principal office. The principal office telephone number: . The street address and county of the principal office of the limited liability company is: Number and Street : City : State: Zip Code: County : The mailing address, if different from the street address , of the principal office of the corporation is: Number and Street: City: State: Zip Code: County: b. The limited liability company does not have a principal office. 4 . The name of the registered agent in the State o f North Carolina is: . 5 . The street address and county of the registered office in the State of North Carolina is: Number and Street: City: State: NC Zip Code: County: 6 .The North Carolina mailing a ddress, if different from the street address, of the registered office in the State of North Carolina is: Number and Street: City: State: NC Zip Code: County: American LegalNet, Inc. www.FormsWorkFlow.com BUSINESS REGISTRATION DIVISION P.O. BOX 29622 RALEIGH, NC 27626-0622 (Revised July 201 7 ) (Form L-09) AP PLICATION FOR CERTIFICATE OF AUTHORITY Page 2 7. The names, titles, and usual business addresses of the current company officials of the limited liability company are: (use attachment if necessary) ( This document must be signed by a person listed in item 7.) Name and Title Business Address 8 . Attached is a certificate of existence (or document of similar import), duly authenticated by the secretary of state or other official having custody of limited liability company records in the state or country of formation. The Certificate of Existence must be less than six months old. A photocopy of the certification cannot be accepted. 9 .I f the limited liability company is required to use a fictitious name in order to transact business in this State, a copy of t he resolution of its managers adopting the fictitious name is attached. 1 0 . (Optional): Please provide a business e - mail address: . - mail the business automatically at the address provided above at no cost when a document is filed. The e - mail provided will not be viewable on the website. For more information on why this service is offered, please see the instructions for this document. 1 1 .This application will be effective upon filing, unless a delayed date and/or time is specified: . This the day of , 20 Name of Limited Liability Company Signature of Company Official Type or Print Name and Title Notes: 1. Filing fee is $250 . This document must be filed with the Secretary of State. American LegalNet, Inc. www.FormsWorkFlow.com