Delaware Division of Corporations
401 Federal Street – Suite 4
Dover, DE 19901
Phone: 302-739-3073
Fax: 302-739-3812
Certificate of Formation of a
Limited Liability Company
Dear Sir or Madam:
Enclosed please find a copy of the Certificate of Formation to be filed in
accordance with the Limited Liability Company Act of the State of Delaware. The fee to
file the Certificate is $90.00. You will receive a stamped filed copy of your submitted
document. A certified copy may be requested for an additional $50. Expedited services
are available. Please contact our office concerning these fees. Please make your check
payable to the “Delaware Secretary of State”.
For the convenience of processing your order in a timely manner, please include a
cover letter with your name, address and telephone/fax number to enable us to contact
you if necessary. Please make sure you thoroughly complete all information requested on
this form. It is important that the execution be legible, we request that you print or type
your name under the signature line.
Thank you for choosing Delaware as your corporate home. Should you require
further assistance in this or any other matter, please don’t hesitate to call us at (302) 739-
Department of State
Division of Corporations
rev. 07/04
First: The name of the limited liability company is
Second: The address of its registered office in the State of Delaware is
in the City of .
Zip code . The name of its Registered agent at such address is
Third: (Use this paragraph only if the company is to have a specific effective date of
dissolution: “The latest date on which the limited liability company is to dissolve is
Fourth: (Insert any other matters the members determine to include herein.)
In Witness Whereof, the undersigned have executed this Certificate of Formation this
day of , .
Authorized Person (s)