State of Utah                               This form must be type written or computer generated.
            Department of Commerce 
            Division of Corporations & Commercial Code 
                                                                                                                                                 Print
            Foreign   Registration Statement (Foreign Limited Liability Company) 
                                                                                                                                                 Clear Form
                                                                                                                                                 Instructions

Important:  Read instructions before completing form                                                              Non-Refundable Processing Fee: $54.00         
1. Exact Name of Foreign Limited Liability Company:
2. Jurisdiction of Formation:
3. Principal office address:
     Street Address Required             ____________________________________________________________________________________________________ 
                                         Address                                                        City                             State           Zip
4. The name of the Registered Agent (Individual or Business Entity or Commercial Registered Agent):
__________________________________________________________________________________________ 
The address must be listed if you have a non-commercial registered agent.  See instructions for further details.  
Address of the Registered Agent: _____________________________________________________________ 
                                         Utah Street Address Required, PO Boxes can be listed after the Street Address 
City:                                                                                                              State  UT         Zip:
5. If the name is not available in Utah the LLC shall use as it’s name:
______________________________________________________________________________ 
                                         Must be the same as number (1) unless the name is not available or permitted in Utah. 
6. Purpose of the Limited Liability Company:
   (optional)
7. Managers/Members of the Limited Liability Company:
   (optional)
Position            Name                 Address                                                                   City                          State      Zip
MANAGER:
MANAGER:
MEMBER:
MEMBER:
Under penalties of perjury, I declare that this application for authority to transact business has been examined by me and is, to the best of my knowledge and belief, 
true, correct and complete. 
Authorized Signature:         Sign here after the form is printed               Name & Title:
Under GRAMA {63G-2-201}, all registration information maintained by the Division is classified as public record.  For confidentiality purposes, you may 
use the business entity physical address rather than the residential or private address of any individual affiliated with the entity. 
Optional Inclusion of Ownership Information:  This information is not required.  
Is this a female owned business?                  Yes                       No 
Is this a minority owned business?                Yes                       No       If yes, please specify:      Select/Type the race of the owner here

Mailing/Faxing Information: www.corporations.utah.gov/contactus.html                                    Division's Website:    www.corporations.utah.gov

06/22