COMMONWEALTH OF VIRGINIA STATE CORPORATION COMMISSION LLC-1052 (07/13) APPLICATION FOR A CERTIFICATE OF REGISTRATION TO TRANSACT BUSINESS IN VIRGINIA AS A FOREIGN LIMITED LIABILITY COMPANY 1. The name of the foreign limited liability company is (include, if required, any "for use in Virginia" name in parentheses) _________________________________________________________________________________________ _________________________________________________________________________________________. 2. The foreign limited liability company was formed under the laws of ________________________________________________ on ______________________________________. (state or other jurisdiction of formation) (date of limited liability company's formation) 3. (Mark if applicable:) The limited liability company was previously authorized or registered with the Commission to transact business in Virginia as a foreign business entity. (See instructions.) Set forth the additional required information on an attachment. 4. A. The name of the limited liability company's registered agent in VIRGINIA is _______________________________________________________________________________________. B. The registered agent is (mark appropriate box): (1) an INDIVIDUAL who is a resident of Virginia and a member or manager of the limited liability company. a member or manager of a limited liability company that is a member or manager of the limited liability an officer or director of a corporation that is a member or manager of the limited liability company. a general partner of a general or limited partnership that is a member or manager of the limited liability company. a trustee of a trust that is a member or manager of the limited liability company. a member of the Virginia State Bar. OR (2) a domestic or foreign stock or nonstock corporation, limited liability company or registered limited liability partnership authorized to transact business in Virginia. C. The limited liability company's VIRGINIA registered office address, including the street and number, if any, which is identical to the business office of the registered agent, is _____________________________________________________________________, VA _____________, (number/street) (city or town) (zip) company. which is physically located in the county or city of __________________________________________. 5. The post office address, including the street and number, of the limited liability company's principal office is _________________________________________________________________________________________. (number/street) (city or town) (state) (zip) 6. The Clerk of the Commission is irrevocably appointed as the agent of the limited liability company for service of process if the company fails to maintain a registered agent in Virginia as required by § 13.1-1015 of the Code of Virginia, the registered agent's authority has been revoked, the registered agent has resigned, or the registered agent cannot be found or served with the exercise of reasonable diligence. 7. The limited liability company is a "foreign limited liability company" as defined in § 13.1-1002 of the Code of Virginia. Signed in the name of the foreign limited liability company by: ______________________________________ (signature) __________________ (date) ____________________________ (telephone number (optional)) ________________________________ (printed name) ______________________________________________________ (title (e.g., member or manager)) (see instructions for requisite signature) Personal Information, such as a social security number, should NOT be included in a business entity document submitted to the Office of the Clerk for filing with the Commission. For more information, see Notice Regarding Personal Identifiable Information at www.scc.virginia.gov/clk/index.aspx. REVIEW THE INSTRUCTIONS THAT FOLLOW BEFORE SUBMITTING THIS FORM. American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS TO FORM LLC-1052 This application, which has been prescribed by the Commission, is required to be filed with the Commission by a foreign limited liability company in order to obtain a certificate of registration to transact business in Virginia. The application must be in the English language, typewritten or printed in black, legible and reproducible, and presented on uniformly white, opaque paper, free of visible watermarks and background logos. See § 13.1-1003 of the Code of Virginia. This form can be downloaded from our website at www.scc.virginia.gov/clk/formfee.aspx Set forth the name of the limited liability company in paragraph 1 exactly as it appears in its articles of organization, as amended, without alteration or abbreviation. If the limited liability company's name does not contain the abbreviation L.C., LC, L.L.C. or LLC, or the words limited company or limited liability company, it must adopt a designated name for use in Virginia that adds one of the foregoing to its name. The limited liability company's name must be distinguishable upon the records of the Commission. See § 13.1-1054 of the Code of Virginia. To check the availability of the limited liability company's name, visit www.sccefile.scc.virginia.gov/NameAvailability or contact the Clerk's Office at (804) 371-9733 or toll-free in Virginia, 1-866-722-2551. If the limited liability company's name is not available, it must adopt a designated name for use in Virginia that is distinguishable upon the records of the Commission. In paragraph 1 of the application, after setting forth the limited liability company's true name, set forth the "for use in Virginia" name in parentheses. See §§ 13.1-1052 and 13.1-1054 of the Code of Virginia. If the limited liability company was previously authorized or registered to transact business in Virginia as a foreign corporation, limited liability company, business trust, limited partnership or registered limited liability partnership, with respect to every such prior authorization or registration, set forth on an attachment the name of the entity, the entity's type, the state or other jurisdiction of incorporation, organization or formation, and the identification number that was issued to the entity by the Commission. The limited liability company may not serve as its own registered agent. The address of the registered office must include a street and number if one is associated with the registered office's location, and the registered office address must be identical to the business of