Important: Read instructions before completing form Non-Refundable Processing Fee: $70.00
1. Name of Limited Liability Company:
2. Principal office address:
Street Address Required
_________________________________________________________________________________________________
Address City State Zip
3. Profession Service Provided:
4. The name of the Registered Agent (Individual or Business Entity or Commercial Registered Agent):
__________________________________________________________________________________________
The address must be listed if you have a non-commercial registered agent. See instructions for further details.
Address of the Registered Agent: _____________________________________________________________
Utah Street Address Required, PO Boxes can be listed after the Street Address
City: State UT
Zip:
5. Name and signature of Organizer (attach additional pages if needed)
Name: Signature:
6. Name and Address of
Members and/or
Managers (required):
1. ___________________________________________________________________________________________ ____________________________
Name Position
___________________________________________________________________________________________________________________________________
Address
City State Zip
2. ___________________________________________________________________________________________ ____________________________
N
a
m
e Position
___________________________________________________________________________________________________________________________________
Address
City State Zip
7. Duration (optional);
The duration of the company shall be perpetual
The duration of the company shall be ___________________________________
Under GRAMA {63G-2-201}, all registration inform
ation maintained by the Division is classified as public record. For confidentiality purposes,
you may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity.
Optional Inclusion of Ownership Information: This information is not required.
Is this a female owned business? Yes No
Is this a minority owned business? Yes No If yes, please specify:
State of Utah
Department of Commerce
Division of Corporations & Commercial Code
Certificate of Organization (Professional Services Limited Liability Company)
This form must be type written or computer generated.
Sign here after the form is printed
Select/Type the race of the owner here
Mailing/Faxing Information:
www.corporations.utah.gov/contactus.html
www.corporations.utah.gov
