S                                                                  (225) 925-4704  
                                         TATE OF LOUISIANA                                                 Commercial Division    
                                        SECRETARY OF STATE                                                   
    R. Kyle Ardoin                                                                                         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         Expedite $30                         Priority Expedite $50
                     24 hour processing                  2-4 hour processing

     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

Daytime 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. O. 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. 06/18

R. Kyle Ardoin    LIMITED LIABILITY COMPANY SUPPLEMENTAL INITIAL REPORT
Secretary of State
                                                  (R.S. 12:1305)

                        Enclose $25 filing fee     Return to:   Commercial Division
                  Make remittance payable to                    P. O. Box 94125
                        Secretary of State                      Baton Rouge, LA 70804-9125 
                        Do Not Send Cash                        (225) 925-4704
                                                                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
SS366 Rev. 05/18                                                                      (see instructions 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.