APPLICATION FOR CERTIFICATE OF AUTHORITY
FOREIGN LIMITED LIABILITY COMPANY
State Form 49464 (R7 / 6-16)
Approved by State Board of Accounts, 2016
Indiana Code 23-18-11-4
23-18-12-3
FILING FEE: $125.00
APPLICATION FOR CERTIFICATE OF AUTHORITY OF
__________________________________________________________________________________________________
The undersigned manager or member desiring to effectuate the admittance of the above Limited Liability Company (LLC) to transact business in
the State of Indiana, certifies the following facts:
ARTICLE I – NAME AND PRINCIPAL OFFICE
Fictitious Name (Only used if name in the application is not available in Indiana.)
Address of Principal Office (number and street )
City
State
ZIP code
ARTICLE II – REGISTERED OFFICE AND AGENT
Name of Registered Agent (Cannot be the organization itself.)
Address of Registered Office (number and street or building – PO box not accepted)
City
State
IN
ZIP code
Required:
By checking the box, the Signator(s) represent(s) that the Registered Agent named in the application has consented to the appointment
of Registered Agent.
ARTICLE III – DATE OF ORGANIZATION AND DURATION OF EXISTENCE
Date of organization in domicilary state (month, day, year)
State of organization
The LLC is perpetual until dissolution.
OR
The latest date upon which the LLC is to dissolve (month, day, year): ________________________
ARTICLE IV – MANAGEMENT
The LLC will be managed by its manager or managers. Yes No
The LLC will be a single member LLC (optional).
In witness whereof, the undersigned being the ___________________________________________________________ of said LLC executes this
(manager or member)
Application for Certificate of Authority, and verifies subject to penalties of perjury, that the facts contained herein are true,
this ______ day of ________________________, 20______.
Signature Printed name
