CERTIFICATE OF ORGANIZATION
PROFESSIONAL
LIMITED LIABILITY COMPANY
(Instructions on back of application)
252
1. The name of the professional limited liability company is:
___________________________________________________________________
2. The complete street and mailing addresses of the initial designated/principal office:
___________________________________________________________________
___________________________________________________________________
3. The name and complete street address of the registered agent:
_________________________
______________________________________
4. The name and address of at least one member or manager of the professional limited
liability company:
___________________________ ______________________________________
___________________________ ______________________________________
___________________________ ______________________________________
___________________________ ______________________________________
5. Mailing address for future correspondence (annual report notices):
___________________________________________________________________
6. Future effective date of filing (optional): ____________________________________
7. The limited liability company is a professional company, and the principal profession or
professions for which members are duly licensed or otherwise legally authorized to render
professional services is: ______________________________________________
Secretary of State use only
g:\corp\forms\LLC forms\cert_org_llc.PMDAddress
Revised 07/2008Signature of an organizer(s). (An organizer is a member,
or is acting in behalf of a required, and existing, initial member
or members).
Signature _______________________________
Typed Name: ___________________________
Signature _______________________________
Typed Name: ___________________________
Name
(Street Address)
(Mailing Address, if different than street address)
(Name)
(Street Address)
INSTRUCTIONS
Optional: If the document is incorrect, telephone number where can you be reached for corrections