Secretary of State OFFICE OF SECRETARY OF STATE CORPOR A TIONS DIVISION 2 Martin Luther King Jr. Dr. SE Suite 313 West Tower Atlanta, Georgia 30334 (404) 656 - 2817 sos.georgia.gov/corporations APPLICATIO N FO R CERTIFICAT E O F AUTHORITY FO R FOREIG N LIMITED LIABILITY COMPANY IMPORTANT : P lease p rovide e mail address w hen completing this form. Primary Em ail Address : NOTICE TO APPLICANT: PRINT PLAINLY OR TYPE REMAINDER OF THIS FORM 1. Name of Limited Liability Company Name Reservation Number (Optional) Date business commenced (or proposed) in Georgia (NOTE: If date provided here is more than 30 da y s prior to the effective date of this application , a $500 penalty plus fees must be paid . P enalty is statutory and cannot be w aived by Secretary of Sta t e.) 2. Name of Fi ling P erson Address City State Zip Code Email Address Telephone Number 3. Name of Limited Liability Company in State or Country of Formation Jurisdiction ( H ome S tate or C ountr y ) Date of Formation in H ome S tate or Country Period of Duration 4. Address of Principal Place of Business City State Zip Code 5. Name of Registered Agent in Georgia Registered Office Street Address in Georgia ( p ost office box or mail drop not acceptable for registered office address) GA City County State Zip Code 6. ( p erson w ith substantial responsibility for managing business activities ) City State Zip Code 7. Address W here Limited Liability Records Are Maintained City State Zip Code 8. Effective Date: (Choose one) Upon filing Delayed effective date and/or time: (A delayed effective date must be within 90 days of the filing date.) 9. NOTICE: Mail the following items to the Secretary of State at the above address (1) This application ; (2) - refundable. This application is signed by a person duly authori z ed to sign s u ch instruments by the la w s of the jurisdiction under w hich the foreign limited liability company is organized. The foreign limited liability company undertakes to keep its records at the address s h o w n in #7 abo v e until its registration in Georgia is canceled or w ithdra w n. The foreign limited liability compan y , in accordance w ith T i tle 14 of the Official Code of Georgia A nnotated, appoints the Secretary of State as agent for ser v ice of process if no agent has been appoi n ted in Georgia or, if appointed, the authority has been re v oked or the agent cannot be found or ser v ed by the exercise of rea s onable diligence. Signature of Authorized Person Date Print Name Title FORM 2 4 1 (Rev 10/2018 American LegalNet, Inc. www.FormsWorkFlow.com