F0200 - Page 1 of 3 OFFICE OF THE MISSISSIPPI SECRETARY OF STATE P.O. BOX 136, JACKSON, MS 39205-0136 (601) 359-1633 Application for Registration of Foreign Limited Liability Company Pursuant to the provisions of House Bill No. 524, Chapter 362, Laws of 1995, the undersigned Limited Liability Company applies for registration to transact business as follows: 1. Name of Limited Liability Company Business Email Address _______________________________________ 2. Organized under laws of the jurisdiction or state of Date Organized 3. Address of the office required to be maintained in the state or jurisdiction of organization by the laws of that state or jurisdiction or, if not required, the address of the principal office of the Limited Liability Company Address City, State, ZIP5, ZIP4 4. If the Limited Liability Company is to have a specific date of dissolution, the latest date upon which this Limited Liability Company is to dissolve 5. Name and Street Address of the Registered Agent and Registered Office in Mississippi Name Address City, State, ZIP5, ZIP4 6. Telephone No. of the Registered Agent 7. The Secretary of State is appointed the Registered Agent of this limited liability company for services of process if the Registered Agent's authority has been revoked or if the Registered Agent cannot be found or served with the exercise of responsible diligence. Rev. 5/2009 American LegalNet, Inc. www.FormsWorkFlow.com F0200 - Page 2 of 3 OFFICE OF THE MISSISSIPPI SECRETARY OF STATE P.O. BOX 136, JACKSON, MS 39205-0136 (601) 359-1633 Application for Registration of Foreign Limited Liability Company 8. Is management of the Limited Liability Company vested in a manager or managers? Yes No 9. Any restrictions or limitations are as follows 10. Other matters the Foreign Limited Liability Company determines to include Rev. 5/2009 American LegalNet, Inc. www.FormsWorkFlow.com F0200 - Page 3 of 3 OFFICE OF THE MISSISSIPPI SECRETARY OF STATE P.O. BOX 136, JACKSON, MS 39205-0136 (601) 359-1633 Application for Registration of Foreign Limited Liability Company 11. Name elected to use in Mississippi By: Signature (Please keep writing within blocks) Printed Name Title Street and Mailing Address Physical Address P.O. Box City, State, ZIP5, ZIP4 Rev. 5/2009 American LegalNet, Inc. www.FormsWorkFlow.com