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APPLICATION FOR CERTIFICATE OF AUTHORITY
FOREIGN LIMITED LIABILITY COMPANY
Submit in Duplicate
John A. Gale, Secretary of State
Room 1301 State Capitol, P.O. Box 94608
Lincoln, NE 68509
(402) 471-4079
http://www.sos.ne.gov
An original certificate of existence from the appropriate authority in the jurisdiction or state under whose
laws the limited liability company was organized must be filed with this document.
NOTE: A certified copy of the company's certificate of organization may not be filed in lieu of a
certificate of existence.
Name of Limited Liability Company_______________________________________________
Alternate Name ________________________________________________________________
(complete only if actual name is unavailable for use or does not comply with Nebraska law)
Name and address of registered agent in Nebraska:
Registered Agent Name:_________________________________________________________
Registered Agent Address:
Address of Principal Office:
If required by state or jurisdiction of organization, office maintained in that jurisdiction;
Street and Mailing Address City State Zip
Organized under the laws of the State or Jurisdiction of ________________________________
Nature of the Business, purposes to be conducted or promoted in this state or professional
services being rendered:
Effective date if other than the date filed _____________
Signature of Authorized Representative Printed name of Authorized Representative
FILING FEE: $120.00
Revised 06/23/15
Neb. Rev. Stat.
§21-156
Street and Mailing Address City State Zip
Street and Mailing Address City State Zip
