APPLICATION FOR CERTIFICATE OF REGISTRATION OF LIMITED LIABILITY COMPANY (PLEASE TYPE OR PRINT CLEARLY IN INK) Pursuant to the provisions of Act 1003 of 1993, 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: ___________________________________________________________________ 1 b. The designated name to be used in Arkansas: ___________________________________________________________________ _____________________________________________________________________________________________ (The Limited Liability Company may use a designated 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 designated 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) (Street Address Line 1) _____________________________________________________________________________________________ (Street Address Line 2) (City, State Zip) 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 Line 1) (Street Address Line 2) _____________________________________________________________________________________________ (City, State Zip) 6. 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 understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days. Executed this _______________ day of _______________________, ________________. ______________________________________________ _____________________________________________ Typed or Printed Name of Signer (Authorized Member or Manager) $300.00 Filing Fee Payable to Arkansas Secretary of State (Signature and designation of Authorized Member or Manager) FL-01 Rev. 10/07 American LegalNet, Inc. www.FormsWorkflow.com