$300.00 Filing Fee Payable to Arkansas Secretary of State FL-01 Rev. 08/15
Arkansas Secretary of
State
1401 W. Capitol, Suite 250, Little Rock, AR 72201
M
ark
M
a
rtin
501-682-3409 • www.sos.arkansas.gov
APPLICATION FOR CERTIFICATE OF REGISTRATION OF
FOREIGN LIMITED LIABILITY COMPANY
(PLEASE TYPE OR PRINT CLEARLY IN INK)
Pursuant to the provisions of Act 1003 of 1993 and Arkansas Code Annotated § 4-32-1002, the undersigned, as the
duly authorized and acting member or managing agent of the Foreign Limited Liability Company named below (the
"Limited Liability Company") for which this statement is submitted, under oath, does hereby state:
1. a. The Name of the Limited Liability Company is:
b. The fictitous name to be used in Arkansas:
2. The state, territory or foreign country under whose laws the Limited Liability Company was organized is:
(The Limited Liability Company Company may use a fictitious name to transact business in Arkansas if its real name is unavailable and it delivers to the
Secretary of State for filing a copy of the resolution of its members, certified by its secretary, adopting a new fictitious name.)
3. Date Organized:
Termination Date:
4. The name and address of the registered agent of the Limited Liability Company upon whom service of process is
authorized to be made in Arkansas is:
Name of Registered Agent
Street Address
State
City
ZIP Code
5. The address of the office required to be maintained in the jurisdiction of its formation by the laws of that
jurisdiction or, if not so required, of the principal office of the Limited Liability Company:
Street Address
City
State
ZIP Code
6. The Limited Liability Company shall deliver, with the completed application, a certificate of existence (or
document of similar import) duly authorized by the Secretary of State or other official having custody of its
records in the state or country under whose laws it is filed.
I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State
is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.
Executed this:
day of
, .
Typed or Printed Name of Signer (Authorized Member of Manager)
Signature and designation of Authorized Member or Manager
