APPLICATION FOR CERTIFICATE OF AUTHORITY LIMITED LIABILITY COMPANY (FOREIGN) Submit in Duplicate John A. Gale, Secretary of State Room 1301 State Capitol, P.O. Box 94608 Lincoln, NE 68509 (402) 471-4079 http://www.sos.ne.gov An original certificate of good standing from the appropriate authority in the jurisdiction or state under whose laws the limited liability company was organized must be filed with this document. NOTE: A certified copy of the company's articles of organization may not be filed in lieu of a certificate of good standing. Name of Limited Liability Company_________________________________________ _____________________________________________________________________ Fictitious Name ________________________________________________________ (complete only if actual name is unavailable for use or does not comply with Nebraska law) Address of Principal Business office: _____________________________________________________________________ Street Address City State Zip Organized under the laws of the State of _________________________ Date of Organization _____________________ Nature of the Business or purposes to be conducted or promoted in this state: ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________ Name and address of registered agent in Nebraska: Registered Agent Name:__________________________________________________ Address: _____________________________________________NE______________ Street Address and post office box number (if any) ____________________________________ Signature of Member or Manager City Zip _________________________________ Printed name of Member or Manager FILING FEE: $120.00 Revised 02/06/2009 Neb. Rev. Stat. 21-2638 American LegalNet, Inc. www.FormsWorkFlow.com