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)  The filing fee of $225.00 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 

                                                                                                                                               FORM 241 
                                                                                                                                                 (Rev 10/2018