P
AUL D. PATE
Secretary of
St
a
t
e
State of
I
owa
TO THE
SECRETARY
OF
STATE
OF THE
STATE
OF IOWA:
LIMITED LIABILITY C
O
M
P
AN
Y
APPLICATION F
O
R
CERTIFICATE OF AUTH
O
R
I
TY
Pursuant to section 802 of the Iowa Revised Uniform Limited Liability Company Act, the undersigned applies
for a certificate of authority to transact business in Iowa and hereby states:
1
.
T
he name o
f
t
he limi
t
ed liabili
t
y company
:
1A. The name the limited liability company will use in Iowa, if different than the legal name of the company named above:
(Refer to note #6 on the back of this form)
2. The limited liability company is formed under the laws of the state (or foreign country) of:
3
.
T
he dura
t
ion o
f
t
he limi
t
ed liabili
t
y company is
:
4. The street and mailing address of its registered office in Iowa and the name of its registered agent at that office:
Name
Address City State
Z
ip
The registered office and registered agent comply with the requirements of section 489.113.*
5. The address of the office required to be maintained in the state of its formation by the law of that state
(if such an address is not required, the address of the principal office of the limited liability company)
:
Address
City State Zip
6. (A) This foreign limited liability company is governed by an operating agreement that establishes or provides for the
establishment of designated series of transferable interests having separate rights, powers, or duties with respect
to specified property or obligations of the foreign limited liability company, or profits and losses associated with the
specified property or obligations. YES NO
(B) All debts, liabilities, and obligations incurred, contracted for, or otherwise existing with respect to a particular
series, if any, are enforceable against the assets of such series only, and not against the assets of the foreign
limited liability company generally. YES NO
7. The effective date and time of this application, if different than the date and time of filing:
(Refer to note #5 on the back of t
his form)
Da
t
e
T
ime
8. A certificate of existence or a record of similar import, signed by the secretary of state or other
official having custody of the company's publicly filed report in the state or other jurisdiction
under whose law the company is formed, accompanies this application.
S
igna
t
ure
Da
t
e
635_0010
1/15
T
ype or prin
t
name and
t
i
t
le
