STATE OF  LOUISIANA                                                  Commercial Division 
                                                                                                             (225) 925-4704 
                                        SECRETARY OF  STATE 
Nancy Landry                                                                                                 Fax Numbers 
SECRETARY OF STATE                                                                                           (225) 932-5314 Corporations
                                                                                                             (225) 932-5317 Legal Services
                                                                                                             (225) 932-5318 ucc

                            TRANSMITTAL INFORMATION 
                                   For All Business Filings 

Please indicate below the level of service requested, payment and contact information 

     Routine
□                   D Expedite $30                      Priority Expedite $50
                     24 hour processing  □              2-4 hour processing

D Check or Money Order Enclosed

*Do not put credit card information on this form. You may save payment information in your geauxBIZ profile under master account.

Business Name (List exactly as it appears in documents) 

Name of person filing document (evidence of filing will be mailed to this person, at address below) 

Address 

City                                    State                                                       Zip Code 

Day1ime phone number                    Fax number                                                  Email address 

NOTE:  Louisiana Law requires all Louisiana notaries to print or type their name and notary or 
        bar roll number on the document. 

                     Mailing Address:  P. 0.  Box 94125,  Baton Rouge,  LA * 70804-9125 
                     Office Location: 8585 Archives Ave.,  Baton Rouge,  LA* 70809 
                                   Web Site Address:  www.sos.la.gov 

SS984  Rev  01 /24 

Nancy Landry                         LIMITED LIABILITY COMPANY SUPPLEMENTAL INITIAL REPORT 
Secretary of State 
                                                                (R.S. 12:1305) 
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                                     Make remittance payable to                P. 0. Box 94125
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'�@·\.•�.i? r;\fllll  .._L -".,:._   Secretary of State                        Baton Rouge, LA 70804-9125
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                                                                               www.sos.la.gov

1. The name of this company is:

2. The names and municipal addresses (not a P.O.  Box only) of the first managers or members are:

Name 

Address 

Name 

Address 

   Name 

Address 

   Name 

Address 

   LLC:                              To be signed by each person who signed the Articles of Organization 

                                                        Date 
5S366 Rev. 01/24                                                                                         (see 1nstruct1ons on back) 

                   INSTRUCTIONS 

1. If a limited liability company's initial managers or members are not named in the
   Initial Report, a Supplemental Report must be filed after they are selected.  The
   Supplemental Report shall set forth the name and address of each manager or
   member

2. The Supplemental Report shall be signed by each person who signed the Articles
   of Organization.