PDF document
- 1 -
                  Arkansas Secretary                                                     of State                                                              
                                                                         1401 W.Capitol,  Suite 250,                            Little Rock, AR 72201
                          John Thurston                                                  501-682-3409 • www.sos.arkansas.gov
                                                                     
         APPLICATION FOR CERTIFICATE OF REGISTRATION OF
                          FOREIGN LIMITED LIABILITY COMPANY
                                     (PLEASE TYPE OR PRINT CLEARLY IN INK) 

Pursuant to the provisions of Act 1041 of 2021 and         Arkansas Code Annotated § 4-3 8-201, the undersigned, as the 
duly authorized and acting member or managing agent of the Foreign Limited Liability Company named below 
(the "Limited Liability Company") for which this statement is submitted, under oath, does hereby state:

1. a. The Name of the Limited Liability Company is:
   b. The fictitious name to be used in Arkansas:
   (The Limited Liability Company Company may use a fictitious name to transact business in Arkansas if its real name is unavailable and it delivers to 
   the Secretary of State for filing a copy of the resolution of its members, certified by its secretary, adopting a new fictitious name.)
2. The state, territory or foreign country under whose laws the Limited Liability Company was organized is:

3. Date Organized:                                         Termination Date:
4. The name and address of the registered agent of the Limited Liability Company upon whom service of process is
   authorized to be made in Arkansas is:

   Name of Registered Agent

   Street Address                                                   City                 State                                  ZIP Code
5. The address of the office required to be maintained in the jurisdiction of its formation by the laws of that
   jurisdiction or, if not so required, of the principal office of the Limited Liability Company:

   Street Address                                          City                          State                                  ZIP Code
6. The address of the principle office located in the State of Arkansas:

   Street Address                                          City                          State                                  ZIP Code
7. The Name and title of at least one officer: (attach additional page, if needed)
   Name                                                             Title (Member, Manager or Managing Member) 
   ________________________________________        ________________________________________________

8. The Limited Liability Company shall deliver, with the completed application, a certificate of existence (or document of similar import) duly authorized by 
   the Secretary of State or other official having custody of its records in the state or country under whose laws it is filed. 
   I affirm that I am the individual authorized to sign on behalf of the aforementioned entity to be formed and that, 
   under penalty of perjury, the information stated in this record is accurate
   Executed this:_________________day of_______________,20____

   Signature of Organizer                                           Typed or printed name

$300.00 Filing Fee Payable to Arkansas Secretary of State                                                                                 FL-01 Rev. 8/21



- 2 -
          Arkansas Secretary                                      of State                       
                                                   1401 W.Capitol,  Suite 250,                  Little Rock, AR 72201
                                                                  501-682-3409 • www.sos.arkansas.gov
          John Thurston 

               Limited Liability Company Franchise Tax

                                         Please Type or Print
In order for this limited liability company to receive its annual franchise tax reporting form,
please complete and file with the Office of the Secretary of State at the time of filing.

_________________________________                            __________________________
Limited Liability Company name as used in Arkansas                Contact person

_________________________________                            __________________________
Street address or Post Office Box number                          City, State, ZIP

_________________________________                            __________________________
Telephone number                                                  E-mail address

                                                   IRS link for obtaining a Federal Tax ID: https://www.irs.gov/businesses/
______________________________________             small-businesses-self-employed/how-to-apply-for-an-ein
Federal Tax ID:

I affirm that franchise taxes are due by May 1st of the year following formation of this entity.

_________________________________                            __________________________
Signature                                                    Title

                                                                                                 Rev. 8/21






PDF file checksum: 3991138880

(Plugin #1/9.12/13.0)