OFFICE OF SECRETARY OF STATE 
                                                                   CORPORATIONS DIVISION 
                                                                   2 Martin Luther King Jr. Dr. SE 
                                                                          Suite 313 West Tower 
                                                                          Atlanta, Georgia 30334 
                                                                           (404) 656-2817 
       Secretary of State                                                 sos.georgia.gov/corporations 
                                                                                                                                        
                                                 APPLICATION FOR CERTIFICATE OF AUTHORITY 
                                                  FOR FOREIGN LIMITED LIABILITY COMPANY 
 
                          IMPORTANT: Please provide the entity’s primary email address when                                                  completing this form.           
   Primary Email Address:  

                                            NOTICE TO APPLICANT: PRINT PLAINLY OR TYPE REMAINDER OF THIS FORM 
 
 1.  
      Name of Limited Liability Company                                                                                                                     Name Reservation Number (Optional) 
       
      Date business commenced (or proposed) in Georgia  (NOTE: If date provided here is more than 30 days prior to the effective date of this 
      application, a $500 penalty plus fees must be paid. Penalty is statutory and cannot be waived by Secretary of State.) 
 
 2. 
      Name* of Filing Person                                                                                                                            
 
      Address                                                                                                                           City                            State             Zip Code 
  
      Filer’s Email Address                                                                                                                  Telephone Number 
 
  3. 
      Name of Limited Liability Company in State or Country of Formation 
   
      Jurisdiction (Home State or Country)                                Date of Formation in Home State or Country                                                 Period of Duration 

 4. 
      Address of Principal Place of Business                                                                                            City                            State             Zip Code 
 5. 
      Name* of Registered Agent in Georgia                                                                                                   Registered Agent’s Email Address  
    
      Registered Office Street Address in Georgia (post office box or mail drop not acceptable for registered office address) 
  
                                                                                                                                                                         GA 
      City                                                   County                                                                                                     State             Zip Code 
        
 6.    
      Manager’s Name* & Address (person with substantial responsibility for managing LLC’s business activities)                              City                       State             Zip Code 
 
 7. 
      Address Where Limited Liability Company’s Records Are Maintained                                                                  City                            State             Zip Code 
 
 8.  Effective Date: (Choose one)           Upon filing  Delayed effective date and/or time: 
                                                         (A delayed effective date must be within 90 days of the filing date.) 
 9.   NOTICE:      Mail the following items to the Secretary of State at the above address 
                   (1)  This application;   
                   (2)  Fee of $235.00 ($225 filing fee + $10 paper filing service charge) payable to “Secretary of State.” Filing fees are non-refundable.    
      This application is signed by a person duly authorized to sign such  instruments by the laws of the                                    jurisdiction under which the            foreign limited 
      liabilitycompany is organized. The foreign limited liabilitycompany undertakesto keep its records at the address shown in #7 above until its 
      registrationin Georgia is canceled or withdrawn. The foreign limited liabilitycompany,                                            in   accordancewith Title 14 of the Official Code of 
      Georgia      Annotated, appoints the Secretary of State as agent for service of process if no agent has been                                      appointed in    Georgia or, if appointed, 
      the agent’s  authority has been revoked or the agent cannot be found or served by the exercise of reasonable diligence. 

    Signature of Authorized Person                                          Date 

    Print Name*                                                                                                                  Title 
  
 * Enter individual’s legal name, i.e. first and last name without use of initials or nicknames. Middle names or initials may be included. 
                                                                                                                                                                                     FORM CD 241 
                                                                                                                                                                                             (Rev 10/2019)