State of New Hampshire 
 
       APPLICATION FOR REGISTRATION AS A FOREIGN PROFESSIONAL LIMITED LIABILITY COMPANY 
       INSTRUCTIONS FOR COMPLETING FORM FPLLC-1 (RSA 304-C:175 OR RSA 304-D:16) 
 
1.  The form must be legibly printed or typed on 8.5” x 11” paper and maintain 1” margins.  Pencil or erasable ink is not 
   acceptable. 
    
2. Article First:  The EXACT name of the professional limited liability company as registered by the Secretary of State 
   from the state or country of formation.  The name must match exactly as on record including punctuation wherever 
   it appears on the Form FPLLC-1 application. 
    
3. Article Second:  To be completed only in the case where a professional limited liability company designation must 
   be used.  RSA 304-D:6 requires the name of a professional limited liability company shall end in “Professional Limited 
   Liability Company”, the abbreviation “P.L.L.C. or similar abbreviation.  If the name of the professional limited liability 
   company does not contain any of these designations, list the name of the professional limited liability company with 
   the word or abbreviation which it elects to add thereto for use in New Hampshire in this article only. 
    
    OR 
   If the limited liability company name is not available for use in New Hampshire, enter the name to be used in New 
   Hampshire.  In this case a trade name application must be filed with an additional $50.00 fee. 
    
4.  Principal business information is optional and is not part of article second.  The registered agent address will be used 
   as the principal office address if no principal office address is listed. 
    
5. Articles Third & Fourth:  State or country of formation and date formed in that state or country. 
    
6. Article Fifth:   Purpose must conform to RSA 304-C:21 and RSA 304-D:1 VI.  RSA 304-D:1 VI  "Professional 
   service'' means any service which may lawfully be rendered only by certified public accountants, public accountants, 
   architects, attorneys, podiatrists, chiropractors, dentists, pharmacists, professional engineers, land surveyors, 
   registered professional nurses, optometrists, physicians and surgeons, psychologists, veterinarians, and all other 
   professionals licensed, registered, certified, or otherwise authorized and permitted to practice independently under the 
   provisions of RSA 309-B, 310-A, 311, 315, 316-A, 317-A, 318, 326-B, 327, 329, 329-B, 330-A, or 332-B. 
    
7. Article Sixth:  Per RSA 304-C:177 IV, a registered agent and registered office must be provided.  The registered 
   agent must reside in New Hampshire.  The registered agent is the person who would receive service of process 
   should the corporation be sued.  The registered office is the registered agent’s business address where the registered 
   agent can be found for in-hand service of process.  A street/physical address must be provided. Your application 
   will not be processed without an agent named or if an out of state address is listed. 
    
8. Article Seventh:  This statement must be completed. 
    
9.  Shall be executed on behalf of the foreign limited liability company by a person with authority to do so under the laws 
   of the state or other jurisdiction of its formation, or, if the foreign limited liability company is in the hands of a receiver, 
   executor, or other court appointed fiduciary, trustee, or other fiduciary, it must be signed by that fiduciary. 
    
10. The total filing fee to register is $100.00, payable to the State of New Hampshire. 
 
PLEASE NOTE:  The name will be searched for availability upon receipt of these documents.  If the filing has been 
accepted, you will receive a filed-stamped copy within 30 days.  If you do not receive an acknowledgement, please 
contact our office.  Checks are deposited upon receipt.  If the check has been cashed, it only indicates we have received 
the document.  A cashed check is not an indication that the document has been accepted and filed.  Please call the 
Corporation Division (603-271-3246) with any questions you may have regarding this application. 

       Mailing Address - Corporation Division, NH Dept. of State, 107 N Main St, Rm 204, Concord, NH 03301-4989 
                 Physical Location - State House Annex, 3rd Floor, Rm 317, 25 Capitol St, Concord, NH 
 
                                                                                        Form FPLLC-1  Instruct 

Print  Reset
                         State of New Hampshire 
 
Filing fee:  $100.00                                                                 Form FPLLC-1 
Use black print or type.                                                             RSA 304-C:175 
                                                                                     & RSA 304-D 
 
                              APPLICATION FOR REGISTRATION AS A 
                     FOREIGN PROFESSIONAL LIMITED LIABILITY COMPANY 
 
PURSUANT TO THE PROVISIONS of the New Hampshire Limited Liability Company laws, the 
undersigned hereby applies for registration to transact business in New Hampshire and for that purpose 
submits the following statement: 
 
FIRST:  The name of the professional limited liability company is                                          
                                                                                                          . 
 
SECOND:  The name which it proposes to register and do business in New Hampshire is                        
                                                                                                           
                                                                                                          . 
 
                                 Principal Business Information: 
  Principal Office Address:                                                                                
                              (no. & street)                       (city/town)    (state)          (zip code) 
  Principal Mailing Address (if different):                                                                
                                              (no. & street)       (city/town)    (state)          (zip code) 
  Business Phone:                                              
  Business Email:                                              
  ____ Please check if you would prefer to receive the courtesy Annual Report Reminder by email. 
 
THIRD:  It is formed under the laws of                             . 
 
FOURTH:  The date of its formation is                              . 
 
FIFTH:  Describe the nature of the business or purposes the professional limited liability company will 
conduct or promote in New Hampshire (and if known list the NAICS code and Sub Code):                       
                                                                                                          . 
 
SIXTH:  The name of the professional limited liability company’s registered agent in New Hampshire is: 
                                                                                                          . 
The complete address of its registered office IN NEW HAMPSHIRE(agent's business address) is: 
                                                                                                          . 
      (no. & street)                                               (city/town)    (state)          (zip code) 
 
EIGHTH:  All the members and managers and those of its officers as required by the laws of its state of 
formation and by RSA 304-D:12 are licensed in one or more states, territories of the United States or the 
District of Columbia to render a professional service described in the statement of purpose of the 
professional limited liability company. 
 
                                              Page 1 of 2 
                                                                                          Form FPLLC-1 

APPLICATION FOR REGISTRATION AS A FOREIGN                                                        Form FPLLC-1 
PROFESSIONAL LIMITED LIABILITY COMPANY                                                                     (Cont.) 

                                          *Signature:
                                 Print or type name:  
                                                         Title:  
                                          Date signed:  

                 Complete address of person signing: 

Note:  The sale or offer for sale of membership interests of the limited liability company will comply with 
the requirements of the New Hampshire Uniform Securities Act (RSA 421-B).  The membership interests 
of the limited liability company:  1) have been registered or when offered will be registered under RSA 
421-B; 2) are exempted or when offered will be exempted under RSA 421-B; 3) are or will be offered in a 
transaction exempted from registration under RSA 421-B; 4) are not securities under RSA 421-B; OR 5) 
are federal covered securities under RSA 421-B.  The statement above shall not by itself constitute a 
registration or a notice of exemption from registration of securities within the meaning of sections 448 and 
461(i)(3) of the United States Internal Revenue Code and the regulation promulgated thereunder. 

* Shall be executed on behalf of the foreign professional limited liability company by a person with authority to do so
  under the laws of the state or other jurisdiction of its formation or, if the foreign limited liability company is in the
  hands of a receiver, executor or other court appointed fiduciary, trustee or other fiduciary, it must be signed by that
  fiduciary.

DISCLAIMER:  All documents filed with the Corporation Division become public records and will be available for 
public inspection in either tangible or electronic form. 

Mailing Address - Corporation Division, NH Dept. of State, 107 N Main St, Rm 204, Concord, NH 03301-4989 
            Physical Location - State House Annex, 3rd Floor, Rm 317, 25 Capitol St, Concord, NH 

                                           Page 2 of 2 
                                                                                         Form FPLLC-1  (7/2016)