STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS Office of the Secretary of State Division of Business Services 148 W. River Street Providence, Rhode Island 02904-2615 (401) 222-3040 INSTRUCTIONS FOR FILING AN APPLICATION FOR TRANSFER OF AUTHORITY Title 7 of the Rhode Island General Laws, 1956, as amended The attached form is designed to meet minimal statutory filing requirements pursuant to the relevant statutory provision. This form and the information provided are not substitutes for the advice and services of an attorney and/or tax specialist. 1. An Application for Transfer of Authority may be filed with the Office of the Secretary of State, Division of Business Services, 148 W. River Street, Providence, RI 02904-2615, in accordance with the provisions of ��7-1.2-1411.1, 7-6-80.1, 7-13-52.1, or 7-16-52.1 of the Rhode Island General Laws, 1956, as amended. 2. There is no filing fee for the Application for Transfer of Authority. Pursuant to the provision of 7-1.2-1411.1, 7-680.1, 7-13-52.1, or 7-16-52.1 the filing fees for the documents required to be filed together with the Application for Transfer of Authority are as follows: Filing a Certificate of Registration for a Limited Partnership Filing an Application for Registration for a Limited Liability Company Filing an Application for Certificate of Authority for a Business Corporation Filing a Notice of Registered Limited Liability Partnership Filing an Application for Certificate of Authority for a Non-Profit Corporation $100.00 $150.00 $310.00 See Form 550 $50.00 3. Checks are to be made payable to "Secretary of State". 4. The Transfer of Authority must be executed by one or more persons authorized to act on behalf of the transferring limited liability company, non-profit corporation, corporation, the general partners of the limited partnership or by a majority of the partners or by one (1) or more partners authorized to execute on behalf of the limited liability partnership. NOTE: If the transferring entity has properly registered one or more fictitious business name statements and the resulting entity is eligible to hold a fictitious business name, the fictitious business names of record will be automatically transferred to the resulting entity. However, in the event one or more of the fictitious business name statements contain an entity ending that is now in conflict with the resulting entity structure, a Correction Statement will be required to resolve the conflict. Please contact our office for specific filing instructions. If you have any questions, please call us at (401) 222-3040, Monday through Friday between 8:30 a.m. and 4:30 p.m. Instructions/Form 612 06/12 American LegalNet, Inc. www.FormsWorkFlow.com No Filing Fee (See Instructions) ID Number: STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS Office of the Secretary of State Division of Business Services 148 W. River Street Providence, Rhode Island 02904-2615 APPLICATION FOR TRANSFER OF AUTHORITY (Insert full name of the entity following the transfer) SECTION I: TO BE COMPLETED BY ENTITY TRANSFERRING AUTHORITY Pursuant to the applicable provisions of the Rhode Island General Laws, 1956, as amended, the undersigned duly qualified foreign (check one box only): Non-Profit Corporation or Limited Partnership or Business Corporation or Limited Liability Partnership Limited Liability Company or submits the following Application for the purpose of transferring its authority to a (check one box only): Limited Partnership or Limited Liability Partnership or Limited Liability Company or Non-Profit Corporation Business Corporation or a. The name of the entity filing this application for transfer is: b. The date on which the entity filing this application qualified to conduct business in the State of Rhode Island: __________________________________________________________________________________________ c. The jurisdiction upon transfer of authority: d. The name of the entity following the transfer of authority is: e. The application for transfer is filed as an accompanying certificate to the partnership or authority for a business corporation or certificate of registration for a limited application for certificate of application for registration for a limited liability company or application for certificate of authority for a non-profit corporation or notice of registration for a registered limited liability partnership (check one box only). f. Form 612 05/12 American LegalNet, Inc. www.FormsWorkFlow.com The application for transfer is accompanied by a certificate of good standing or legal existence issued by the proper officer of the state or country under the laws of which it is incorporated. SECTION II: TO BE COMPLETED BY ENTITY TRANSFERRING AUTHORITY Under penalty of perjury, I/we declare and affirm that I/we have examined this Application for Transfer of Authority, including any accompanying attachments, and that all statements contained herein are true and correct and that the undersigned is authorized to sign this certificate on behalf of the entity set forth in Section 1A. Date: Print Name of Other Entity By: Signature of Authorized Person By: Signature of Authorized Person OR By: Print Name of Partnership Signature of Partner By: Signature of Partner By: Signature of Partner Print Name of Corporation By: Signature of Authorized Person By: Signature of Authorized Person OR By: Print Name of Limited Liability Company Signature of Authorized Person By: Signature of Authorized Person American LegalNet, Inc. www.FormsWorkFlow.com