Print Form
For Offi ce Use Only
APPLICATION FOR RENEWAL
OF REGISTRATION OF
FOREIGN L.L.C. NAME
Corporate Filings
312 Rosa L. Parks Avenue
6
th
Floor, William R. Snodgrass Tower
Nashville, TN 37243
To the Secretary of State of the State of Tennessee:
Pursuant to the provisions of §48-207-103(d) of the Tennessee Limited Liability Company Act or §48-249-
108(d) of the Tennessee Revised Limited Liability Company Act, the undersigned limited liability company
hereby applies for renewal of the registration of its limited liability company name or assumed limited liability
company name to and including December 31,
and submits the following statement:
1. The name of the Limited Liability Company is:
If different, the name to be registered in the State of Tennessee is:
NOTE: The name must be distinguishable upon the records of the Secretary of State under §48-207-101(b)
of the Tennessee Revised Limited Liability Company Act or §48-249-106(b) of the Tennessee Revised
Limited Liability Company Act, as applicable.
2. The state or country of the organization is:
3. [Optional] The date of organization is
(month, day and year).
4. The nature of the business of the limited liability company is:
NOTE: This application must be accompanied by a certifi cate of existence (or document of similar import)
duly authenticated by the Secretary of State or other offi cial having custody of limited liability com-
pany records in the state or country under whose law it is organized. The certifi cate shall not bear
a date of more than one (1) month prior to the date the application is fi led in this state.
Mailing address line 1
Name of Limited Liability Company
Mailing address line 2
Signature
Date
City/State/Zip Code
Name (typed or printed) and Signer's Capacity
(if other than individual capacity)
SS-4237 (Rev. 09/06)
Filing Fee $20
RDA 2458