Organization Information1.The name of the limited liability co. applying to do business in WV:2.The company was organized under the laws of the State of:Date of Organization: The address of the principal office of the organization is: 3.6.Are on site contractual services provided to another business located in WV? YES / NO If yes, please describe: State: Street: Name: Zip Code:7.Will you maintain an office in WV? If "Yes," where? City: NoYes, at: Will you apply for a contractor222s license for construction work? NoYes Is the business in the state limited to sales? If "Yes," answer a-d. NoYes a.Does any salesperson reside in the state? NoYes b.Will any salesperson need WV Workers222 Comp. coverage?The type of business to be conducted in WV is:5.Business/Employees in WV: No Yes c.Does your salesperson have authority to finalize a contract? No Yes .d.How are goods shipped to your customers? Common Carrier 10.Do you expect work to be limited to only one occasion8.9.No, we plan on multiple jobs or on-going business.of no more than one month?Yes, Beginning: Ending:11.Will you have employees, other than sales people, working within the state? If "Yes," answer a-c.No a.Will WV taxes be withheld?b.Will they have WV Unemployment Coverage? NoYesYesYes Company Vehicles No Yes Control #FILING FEE:FILE ONE ORIGINAL (Two if you want a filed stamped copy returned to you.)$25.00APPLICATION FOR EXEMPTION FROM CERTIFICATE OF AUTHORITY OF A LIMITED LIABILITY COMPANY 4.The name and address of the Agent(person or company) to whomnotice of process may be sent,if any, will be:c.Will they have WV Workers' Compensation Coverage?No Street: State: Zip Code: City: Continued on page 2 of this application. Form LLF-2 Rev. 11/2017West Virginia Secretary of State Business & Licensing Division Tel: (304)558-8000 Fax: (304)558-8381 Website: www.wvsos.gov which makes your business exempt from being required to have a 24731B-10-1003List section number of the WV Code12.Basis for Claiming Exemption: (A)Code Number:List the section number (see attached list) in the blank space provided below. certificate of authority.Date:Contact phone number (w/ area code):Title/Capacity:Print name of signer:13. Signature:Page 2Application for Exemption from Certificate of Authority of Limited Liability Company File with the Secretary of State one original signed application, or if you would like a filed copy returned to you submit two applications. The filing fee is $25 and you should make checks payable to the WV Secretary of State. The Secretary of State will determine, based on the information you provide, whether an exemption may be granted or whether your company will be required to obtain a certificate of authority prior to beginning business. Please note that a company may not obtain a business license, obtain workers compensation or unemployment insurance, or obtain other licenses and permits without first obtaining either an exemption or a certificate of authority. If your company is not eligible for an exemption, then the exemption application will be returned to you and you will have to file for a certificate of authority. Before completing this application please review the provision of the West Virginia Code. If you believe the nature and extent of your organization222s activity in West Virginia will qualify your company to conduct business without obtaining a certificate of authority under one of the listed exemptions, you may apply for an exemption by completing the exemption application and mailing the form to the address on the top of the application. A fee of $25 for an exemption certificate is required. Instructions for Applying for Exemption from Certificate of Authority of a Limited Liability Company). Important Legal Notice Regarding Signature *(See belowstructure) of the limited liability company The application needs to be signed by a member (or manager, depending on the type of management . Liability for false If a record authorized or required to be filed under this chapter contains a false 24731B-2-209West Virginia Code Per: Important Legal Notice Regarding Signature*COMPANYWEST VIRGINIA CODE ON OBTAINING AN EXEMPTION FOR A LIMITED LIABILITY the time the record was signed. who signed the record or caused another to sign it on the person's behalf and knew the statement to be false at statement, one who suffers loss by reliance on the statement may recover damages for the loss from a person statement in filed record. . Activities not constituting transacting business. 24731B-10-1003 the foreign limited liability company in another state; and Applying for withholding tax on an employee residing in the State of West Virginia who works for (11)Transacting business in interstate commerce; (10)course of repeated transactions of a like nature; Conducting an isolated transaction that is completed within thirty days and that is not one in the (9)debts, and holding, protecting and maintaining property so acquired; Securing or collecting debts or enforcing mortgages and security interests in property securing the (8)Creating or acquiring indebtness, mortgages and security interests in real or personal property; (7)orders require acceptance outside this state before they become contracts; Soliciting or obtaining orders, whether by mail or through employees or agents or otherwise, if the (6)Selling through independent contractors; (5)own securities or maintaining trustees or depositories with respect to those securities; Maintaining offices or agencies for the transfer, exchange and registration of the foreign company222s (4)Maintaining bank accounts; (3)affairs; Holding meetings of its members or managers or carrying on other activities concerning internal (2)Maintaining, defending or settling any proceeding; (1)within the meaning of this article include: (a) Activities of a foreign limited liability company that do not constitute transacting business in this State (c)This section does not apply in determining the contracts or activities that may subject a foreign limited liability company to service of process, taxation or regulation under any other law of this State. (b)For purposes of this article, the ownership in this State of income-producing real property or tangible personal property, other than property excluded under subsection (a) of this section, constitutes transacting business in this State. (12)Holding all, or a portion thereof, of the outstanding stock of another corporation authorized to transact business in the State of West Virginia: Provided, that the foreign limited liability company does not produce goods, services or otherwise conduct business in the State of West Virginia. CHOOSE ONE OF THE FOLLOWING PROCESSING SERVICES: 1 EXPEDITED SERVICE (24-hour, 2-hour and 1-hour; *Requires standard filing fee plus additional expedite fee, see below) West Virginia Secretary of State Business & Licensing Division Tel: (304) 558-8000 Fax: (304) 558-8381 Website: www.wvsos.gov Filing Submission Instructions - Business DivisionSUBMIT THE COMPLETED APPLICATION WITH THE CUSTOMER ORDER REQUEST FORM TO ONE OF THE OFFICES BELOW. CHOOSE EXPEDITED OR STANDARD PROCESSING SERVICE. IF NOT USING THE CUSTOMER ORDER REQUEST FORM AND YOU ARE REQUESTING EXPEDITED SERVICE, YOU MUST INCLUDE THE WORD "EXPEDITE" AND THE LEVEL OF EXPEDITED SERVICE BEING REQUESTED (24-HOUR, 2-HOUR OR 1-HOUR) IN YOUR CORRESPONDENCE. BE SURE TO INCLUDE THE CORRECT ADDITIONAL EXPEDITED FEE. THIS FEE IS IN ADDITION TO THE REGULAR FILING FEE (SEE FEES BELOW).BUSINESS SERVICE CENTERS Standard and Expedited Filings Charleston Office One-Stop Business Center 1615 Washington Street East Charleston, WV 25311 Phone: (304) 558-8000 Fax: (304) 558-8381 Hours: Mon. - Fri. 8:30a - 5:00p EST Clarksburg Office North Central WV Business Center 200 West Main Street Clarksburg, WV 26301 Phone: (304) 367-2775 Fax: (304) 627-2243 Hours: Mon. -Fri. 9:00a - 5:00p EST Martinsburg Office Eastern Panhandle Business Center 229 E. Martin Street Martinsburg, WV 25401 Phone: TBA Fax: TBA Hours: Mon. - Fri. 9:00a - 5:00p ESTIMPORTANT: READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING FORMS. Please follow the instructions included with th