PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS Return document by mail to: Name Address City State Zip Code Return document by email to: _________________________________ Read all instructions prior to completing. Fee: $70 In compliance with the requirements of the applicable provisions of 15 Pa.C.S. § 8832 (relating to certificate of authority), the undersigned limited liability company, desiring to effect a certificate of authority (or amendment or cancellation thereto) hereby states that: I. Required fields for Certificate, Amendment or Cancellation 1. The name of the limited liability company is: _________________________________________________________ 2. The current registered office address as on file with the Department of State. Complete part (a) OR (b) ­ not both: (a) _______________________________________________________________________________________________ Number and street City State Zip County (b) c/o: ____________________________________________________________________________________________ Name of Commercial Registered Office Provider County II. Certificate of Company Authority Only 1. All persons holding the following position (e.g., Managing Member, Manager) _________________________ with respect to the company has the authority to do the following: Check all that apply. For additional positions, attach additional pages as needed. Sign an instrument transferring real property held in the name of the company. Other specification or limitation may be provided. Additional pages may be attached as needed. __________________________________________________________________________________________ __________________________________________________________________________________________ Enter into other transactions on behalf of, or otherwise act for or bind, the company. Other specification or limitation may be provided. Additional pages may be attached as needed. __________________________________________________________________________________________ __________________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com DSCB:15-8832 ­ 2 2. The following named person (i.e., John Smith) __________________________________ has the authority to do the following: Check all that apply. For additional persons, attach additional pages as needed. Sign an instrument transferring real property held in the name of the company. Other specification or limitation may be provided. Additional pages may be attached as needed. __________________________________________________________________________________________ __________________________________________________________________________________________ Enter into other transactions on behalf of, or otherwise act for or bind, the company. Other specification or limitation may be provided. Additional pages may be attached as needed. __________________________________________________________________________________________ __________________________________________________________________________________________ III. Amendment to Certificate of Company Authority If amending a Certificate of Authority previously filed in the Department of State, check the box below and complete the following: The Certificate of Company Authority that became effective on _______________________ is amended. Date (MM/DD/YYYY) The contents of the amendment are stated below. Additional pages may be attached as needed. _________________________________________________________________________________________________ _________________________________________________________________________________________________ IV. Cancellation of Certificate of Company Authority If cancelling a Certificate of Authority previously filed in the Department of State, check the box below and complete the following. The Certificate of Company Authority that became effective _________________________ is cancelled. Date (MM/DD/YYYY) IN TESTIMONY WHEREOF, the undersigned has caused this Certificate of Company Authority to be signed by a person duly authorized by the company thereof this _______ day of ______________________, 20_______. ______________________________________________________________ Name of Limited Liability Company ______________________________________________________________ Signature ______________________________________________________________ Title American LegalNet, Inc. www.FormsWorkFlow.com DSCB:15-8433 ­ Instructions Pennsylvania Department of State Bureau of Corporations and Charitable Organizations P.O. Box 8722 Harrisburg, PA 17105-8722 (717) 787-1057 Website: www.dos.pa.gov/corps General Information Typewritten is preferred. If handwritten, the form must be legible and completed in black or blue-black ink in order to permit reproduction. The nonrefundable filing fee for this form is $70. Checks should be made payable to the Department of State. Checks must contain a commercially pre-printed name and address. This form and all accompanying documents, including any necessary governmental approvals, shall be mailed to the address stated above. Who should file this form? This form may be used by a limited liability company to set forth, amend or cancel company authority. With the exception of manager-managed limited liability companies identified as such in their certificates of organization, other law ­ especially the common law of agency ­ determines the apparent authority to bind a limited liability company. This apparent authority may be altered by the filing or recording of a Certificate of Company Authority under 15 Pa.C.S. § 8832, which establishes the mechanics for and the legal effect of filing or recording a Certificate of Company Authority. Applicable Law For relations of members and managers to persons dealing with limited liability company, in general, see 15 Pa.C.S. §§ 8831-8835. Statutes are available on the Pennsylvania General Assembly website, www.legis.state.pa.us, by following the link for Statutes. I. 1. Give the exact name of the limited liability company. The name on this line must match exactly the company name as on file with the Department at the time the Certificate of Company Authority is submitted for filing. This field is required. I. 2. Current address. The address provided must be the company's registered office address on file with the Department of State at the time the Certificate of Company Authority is submit