Brian P. Kemp
Secretary of State
OFFICE OF SECRETARY OF STATE
CORPORATIONS DIVISION
2 Martin Luther King Jr. Dr. SE
Suite 313 West Tower
Atlanta, Georgia 30334
(404) 656-2817
sos.georgia.gov/corporations
APPLICATION FOR CERTIFICATE OF AUTHORITY
FOR FOREIGN LIMITED LIABILITY COMPANY
IMPORTANT
Provide your e-mail address when
completing
this
form.
E-Mail:
NOTICE TO APPLICANT: PRINT PLAINLY OR TYPE REMAINDER OF THIS FORM
1.
Name of Limited Liability Company Name Reservation Number (Optional)
Date business commenced (or proposed) in Georgia (NOTE: If date provided here is more than 30 days prior to the date the application is
received by the Secretary of State, a $500 penalty plus fees must be paid. Penalty is statutory and cannot be waived by Secretary of State.)
2.
Name of Filing Person Telephone Number
Address City State Zip Code
3.
Name of Limited Liability Company in State or Country of Formation
Jurisdiction (Home State or Country) Date of Formation in Home State or Country
4.
Address of Principal Place of Business City State Zip Code
5.
Name of Registered Agent in Georgia
Registered Office Street Address in Georgia (post office box or mail drop not acceptable for registered office address)
GA
City County State Zip Code
6.
Manager’s Name & Address (person with responsibility for maintaining records) City State Zip Code
7.
Address Where Limited Liability 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 the following items to the Secretary of State at the above address
(1) This form;
(2) The filing fee of $225.00 payable to “Secretary of State.” Filing fees are non-refundable.
This
application
is signed by a person duly
authorized
to sign such
instruments
by the laws of the
jurisdiction
under which
the
foreign
limited liability
company is organized. The foreign limited liability
company
undertakes
to keep its records at the
address shown in #7 above until its
registration
in Georgia is canceled or
withdrawn.
The foreign limited liability
company, in
accordance
with Title 14 of
the
Official Code of Georgia
Annotated, appoints
the Secretary of State as agent for service of
process if no agent has been
appointed
in
Georgia or, if appointed, the agent’s
authority
has been revoked or the agent cannot
be found or served by the exercise of
reas
onable diligence.
Signature of Authorized Person Date
Print Name Title
FORM 241
(Rev. 4/2015)
