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State of Wisconsin FILING FEE $100.00 +

DEPARTMENT OF FINANCIAL INSTITUTIONS Please check box to request 
Division of Corporate & Consumer Services + $25.00
Optional Expedited Service

FOREIGN REGISTRATION STATEMENT
FORM 521
Mandatory LIMITED LIABILITY COMPANY
Sec. 183.0903, Wis. Stats.

1. Name of Foreign Limited Liability Company:

2. If the name is not distinguishable from a name that another entity has already reserved or registered
with the Department, enter a fictitious name adopted pursuant to s. 183.0906(1), Wis. Stats.:

3. Organized under the laws of (provide the state (other than Wisconsin) or the foreign country of the
foreign limited liability company’s governing law):

4. Name of the foreign limited liability company’s registered agent in Wisconsin:

5. Email address of the registered agent

6. Street address of the registered office in Wisconsin

City State Zip/Postal code
WI

7. Street address of the principal office (may be located outside Wisconsin)

City State/Province Country Zip/Postal code

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8. Mailing address of the principal office (if different than street address)

City State/Province Country Zip/Postal code

9. If the foreign limited liability company’s governing law requires it to maintain an office within the
jurisdiction of its governing law, provide the street and mailing addresses of that office in the blanks
provided for items 9a and 9b below. If the foreign limited liability company’s governing law does not
so require, leave items 9a and 9b blank.

9a. Street address

City State/Province Country Zip/Postal code

9b. Mailing address (if different than street address)

City State/Province Country Zip/Postal code

10. The above-named entity is a foreign limited liability company.

11. Prior to submitting this registration statement, did the foreign limited liability company transact
business in Wisconsin without having registered?

 
No Yes If “Yes”, complete Supplement on page 4 to determine applicable fee.

12. This document must be signed by a person authorized by the company:

Signature Date

Printed Name Title

(Optional) This document has a delayed effective date/time of: _______________________________
(up to 90 days after received date)

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Contact Information:

Name

Mailing Address

City State Zip Code

Email Address Phone Number

Important annual report requirements, once your entity is formed on our records. This entity type has an
annual report requirement to file each year, starting the year after your entity was formed. Your annual report
due date is listed in the table below. You may file your annual report online, by visiting www.dfi.wi.gov, below
the State of Wisconsin image, you will see a box labeled “File Annual Report,” click on “File Here” and you
will be directed to file online.

INSTRUCTIONS (Refer to section 183.0903, Wis. Stats., for document content)

Please use BLACK ink. Submit one original to State of WI-Dept. of Financial Institutions, Box 93348,
Milwaukee WI, 53293-0348, together with a check for the filing fee of the amount calculated in the Supplement
or $100.00 (if not required to complete the Supplement), payable to the Department of Financial Institutions. (If
sent by express or priority U.S. mail, please mail to State of WI-Dept. of Financial Institutions, Division of
Corporate and Consumer Services, 4822 Madison Yards Way, 4th Fl., North Tower, Madison WI, 53705.) If
requesting optional expedited service, please check the expedited service box in the upper-right corner of the
first page and include an additional $25.00. Filing fees are non-refundable. This document can be made
available in alternate formats upon request to qualifying individuals with disabilities. Upon filing, the
information in this document becomes public and might be used for purposes other than those for which it was
originally furnished. If you have any questions, please contact the Division of Corporate & Consumer Services
at 608-261-7577 (hearing-impaired may call 711 for TTY) or by email atDFICorporations@dfi.wisconsin.gov .

Item 1. Enter the name of the foreign limited liability company that is registering with the Department.

Item 2. The name under which the foreign limited liability company is registered in this state must be
distinguishable on the records of the Department from other entities that are registered with the Department and
from any name that has been reserved or registered with the Department. You can preliminarily check the
availability of an entity name using the Department’s corporate records database, which is publicly available
through the Department’s website.

If the name of the foreign limited liability company is not distinguishable on the records of the department as
provided in s. 183.0112(2), Wis. Stats., enter a fictitious name under which the entity will do business in this
state. The name must contain the phrase “Limited Liability Company” or “Limited Company” or the
abbreviation “LLC,” “LC,” or a variation of these abbreviations that differs only with respect to capitalization of

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letters or punctuation. In addition, the word “limited” may be abbreviated as “Ltd.” and the word “company”
may be abbreviated as “Co.”

Item 3. Enter the name of the jurisdiction (either a state other than Wisconsin or a foreign country) under
whose laws the foreign limited liability company is organized.

Items 4 & 5. Enter the name of the limited liability company’s registered agent in this state and the email
address of that agent. Annual report forms, notices and other official communications are directed to the
entity’s registered agent, so it is important to keep this information current.

Item 6. The entity must have a registered agent located at a registered office in Wisconsin. The registered
office address must be identical to the registered agent’s business office and must be an actual physical location
with a street address, and not solely a P.O. Box, mailbox service, or telephone answering service. Provide the
street number and name, city and ZIP code in Wisconsin.

Items 7 & 8. Enter the street address and, if different, the mailing address of the entity’s principal office. The
entity’s principal office may be located outside Wisconsin.

Item 9. If the foreign limited liability company’s governing law requires it to maintain an office within the
jurisdiction of its governing law, provide the street and mailing addresses of that office in the blanks provided
for items 9a and 9b. If the foreign limited liability company’s governing law does not so require, leave items 9a
and 9b blank.

Item 10. This is a statement confirming that the company is a foreign limited liability company. If the
company is a different type of entity, do not file this form and instead visit the Department’s website to locate
the proper form for your organization’s entity type.

Item 11. Indicate whether the foreign limited liability company has done business in Wisconsin prior to filing
this foreign registration statement. If the answer is “yes,” complete the Supplement below. Note that not all
commercial activities within the state constitute “doing business in this state” for purposes of this question. For
a list of activities that do not constitute doing business in this state for purposes of this question, review s.
183.0905, Wis. Stats.

Item 12. The document must be executed by one or more persons authorized by the company.

Optional delayed effective date/time. This document may declare a delayed effective date and time. The
effective date/time may not be before, or more than 90 days after, the document is received by the Department
of Financial Institutions for filing. If no effective date/time is specified, the document will take effect at the
close of business on the date it is received for filing by the Department.

SUPPLEMENT

a. Enter a whole number equal to the number of calendar years (not including the
current year) in which the company did business in Wisconsin without having
registered with the Department, counting any partial calendar years as full years: ________

b. Multiply that number by $97.50 ($65 annual report fee plus a 50 percent penalty as
provided in s. 183.0902(6), Wis. Stats.) $_________

c. Standard Registration Fee: + $ 100.00___

Total filing fee: $_________

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