Form Flc - Certificate Of Authority Flc (Foreign Limited Liability Company)
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1
2C
K
OMMONWEALTH OF
ENTUCKY
T
G
, S
S
REY
RAYSON
ECRETARY OF
TATE
_________________________________________________________________________________________________________________________
Division of Corporations
Certificate of Authority
FLC
Business Filings
(Foreign Limited Liability Company)
PO Box 718
Frankfort, KY 40602
(502) 564-3490
Pursuant to the provisions of KRS Chapter 275, the undersigned hereby applies for authority to transact business in Kentucky on behalf
of the limited liability company named below and, for that purpose, submits the following statements:
1. The company is
a limited liability company (LLC) or
a professional limited liability company (PLLC).
2. The name of the limited liability company is ______________________________________________________________________.
3. The name of the limited liability company to be used in Kentucky is____________________________________________________.
(Only provide if “real name” is unavailable for use; otherwise leave blank).
4. The state or country of organization is __________________________________________________________________________.
5. The date of organization __________________________and, if the limited liability company has a specific date of dissolution, the
latest date upon which the limited liability company is to dissolve is ______________________________________________________.
6. The street address of the registered office in Kentucky is:
___________________________________________________________________________________________________________.
Street Address Only (No Post Office Box Numbers)
City
State
Zip Code
7. The name of the registered agent at that office is _________________________________________________________________.
8. The principal address of the limited liability company is:
___________________________________________________________________________________________________________
Street Address or Post Office Box Numbers
City
State
Zip Code
9. The names and mailing addresses of the current members/managers:
___________________________________________________________________________________________________________
Name
Street Address or Post Office Box Numbers
City
State
Zip Code
___________________________________________________________________________________________________________
Name
Street Address or Post Office Box Numbers
City
State
Zip Code
10. This application will be effective upon filing, unless a delayed effective date and/or time is provided. The effective date or the
delayed effective date cannot be prior to the date the application is filed. The date and/or time is ______________________________.
)
(Delayed effective date and/or time
I certify that, as of the date of filing this application, the above-named limited liability company validly exists as a limited liability
company under the laws of the jurisdiction of its formation.
I declare under penalty of perjury under the laws of the state of Kentucky that the foregoing is true and correct.
___________________________________________________________________________________________________________
Signature of Member, Manager or Authorized Party
Printed Name & Title
Date
I, ______________________________________________________, consent to serve as the registered agent on behalf of the limited
Print Name of Registered Agent
liability company.
___________________________________________________________________________________________________________
Signature of Registered Agent
Printed Name & Title
Date
09/09
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