State of Utah Department of Commerce Division of Corporations & Commercial Code Foreign Registration Statement (Foreign Limited Liability Company) Print Clear Form Instructions Important: Read instructions before completing form 1. Exact Name of Foreign Limited Liability Company: 2. Jurisdiction of Formation: 3. Principal office address: ____________________________________________________________________________________________________ Address City State Zip Non-Refundable Processing Fee: $70.00 4. The name of the Registered Agent (Individual or Business Entity or Commercial Registered Agent): __________________________________________________________________________________________ The address must be listed if you have a non-commercial registered agent. See instructions for further details. Address of the Registered Agent: City: _____________________________________________________________ Utah Street Address Required, PO Boxes can be listed after the Street Address State UT Zip: 5. If the name is not available in Utah the LLC shall use as it's name: ______________________________________________________________________________ Must be the same as number (1) unless the name is not available or permitted in Utah. 6. Purpose of the Limited Liability Company: (optional) 7. Managers/Members of the Limited Liability Company: (optional) Position MANAGER: MANAGER: MEMBER: MEMBER: Name Address City State Zip Under penalties of perjury, I declare that this application for authority to transact business has been examined by me and is, to the best of my knowledge and belief, true, correct and complete. Authorized Signature: Sign here after the form is printed Name & Title: Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity. Optional Inclusion of Ownership Information: This information is not required. Is this a female owned business? Yes No Is this a minority owned business? Yes No If yes, please specify: Select/Type the race of the owner here Mailing/Faxing Information:www.corporations.utah.gov/contactus.html Division's Website: www.corporations.utah.gov 01/14 American LegalNet, Inc. www.FormsWorkFlow.com