City County St a te Zip Code Jurisdiction (Home State or Countr y ): Date of Formation in Home State: Period of Duration: Brian P. Kemp Secretary of State OFFICE OF SECRETARY OF STATE CORPOR A TIONS DIVISION 2 Martin Luther King Jr. Dr. SE Suite 313 West Tower Atlanta, Georgia 30334 (404)656 - 2817 sos.georgia.gov/corporations APPLICATIO N FO R CERTIFICAT E O F AUTHORITY FOR FOREIGN LIMITED LIABILITY PARTNERSHIP IMPORTANT : P lease p rovide e mail address w hen completing this form. Primary Em ail Address : NOTICE TO APPLICANT: PRINT PLAINLY OR TYPE REMAINDER OF THIS FORM 1. Name of Limited Liability Partnership Name Reservation Number (Optional) Date business commenced (or proposed) in Georgia (NOTE: Pursuant to O.C.G.A. 14 - 8 - 54, if the date provided here is more t han 30 da y s prior to the effective date of this application, a $500 penalty FOR EACH Y EAR OR PART THEREOF plus fees must be paid.) 2. Name of F iling P erson Address City State Zip Code Email Address Telephone Number 3. Principal Office Mailing Address City State Zip Code 4. Name of Registered Agent in Georgia Email Address Registered Office Street Address in Georgia (Post office box or mail drop not acceptable for registered office address) GA 5. Name of Limited Liability Partnership in State or Country of Formation 6. Managing Name & Address City State Zip Code 7. Address Where Limited Liability Partnership Records Are Maintained City State Zip Code 8. Effective Date: (Choose one) Upon filing Delayed effective date and/or time: (A delayed effective date must be within 90 days of the filing date.) 9 . NOTICE: Mail or deli v er the follo w ing items to the Secretary of State at the abo v e address. (1) This application ; and (2) F iling fee of $200.00 pa y able to of State . Filing fees are non - refundable. This application is signed by a person duly authorized to sign such instruments by the la w s of the jurisdiction under w hich the foreign limited liability partnership is organized. The foreign limited li a bility partnership undertakes to keep its records at the address s h o w n in #7 abo v e until its registration in Georgia is canceled or w ithdra w n. The f o reign limited liability partnership, in accordance w ith Title 14 of the Official Code of Georgia A nnotated, appoints the Secretary of State as agent for ser v ice of process if no agent has been appointed in Georgia o r , if appointed, authority has been re v oked or the agent cannot be found or ser v ed by the exercise of reasonable diligence. Signature of Authorized Person Date Print Name Title FORM 2000 (Rev. 12/2017 ) American LegalNet, Inc. www.FormsWorkFlow.com
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