DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.
APPLICATION FOR REGISTRATION
OF FOREIGN LIMITED LIABILITY COMPANY
L025i
1.
Please read Instructions
ENTITY TYPE
check only one
to indicate the type of entity applying for registration:
LIMITED LIABILITY COMPANY PROFESSIONAL LIMITED LIABILITY COMPANY
2. NAME IN STATE OR COUNTRY OF FORMATION (FOREIGN NAME) –
enter the exact, true
name of the foreign LLC:
_____________________________________________________________________
3. NAME TO BE USED IN ARIZONA (ENTITY NAME) –
identify the name the foreign LLC will
use in Arizona by checking 3.1 or 3.2 (check only one), and follow instructions
:
3.1
Name in state or country of formation
, with no changes or additions – go to
number 4 and continue.
3.2
Fictitious name
– check this if the foreign LLC’s name in its state or country of
formation is not available for use in Arizona or if that name does not contain an LLC
identifier, and enter the name in number 3.3 below.
NOTE –
a resolution of the
company adopting the fictitious name must be attached to and submitted with this
form.
3.3 If you checked 3.2
, enter or print the name to be used in Arizona:
4. PROFESSIONAL LIMITED LIABILITY COMPANY SERVICES –
if professional LLC is checked
in number 1 above, describe the professional services that the professional LLC will provide
(examples: law firm, accounting, medical):
5. FOREIGN DOMICILE –
list the state or country in which the foreign LLC was formed:
______________________________________________________________________
6. DATE OF FORMATION IN FOREIGN DOMICILE:
____________________________________
7. PURPOSE OR GENERAL CHARACTER OF BUSINESS –
describe or state the purpose of the
foreign LLC or the general character of the business it proposes to transact in Arizona:
_____________________________________________________________________________
L025.001 Arizona Corporation Commission - Corporations Division
Rev: 2010 Page 1 of 3
______________________________________________________________
Clear Form
Print Form
8. STATUTORY AGENT IN ARIZONA:
8.1
REQUIRED
give the name (can be
an individual or an entity) and physical
or street address (not a P.O. Box) in Arizona
of the statutory agent:
8.2
OPTIONAL - m
ailing address in Arizona of
statutory agent, if different from street address
(can be a P.O. Box):
Statutory Agent Name (required)
Attention (optional) Attention (optional)
Address 1 Address 1
Address 2 (optional)
City
State Zip
Address 2 (optional)
City State Zip
8.3
REQUIRED
the Statutory Agent Acceptance
form M002 must be submitted along with
this Application For Registration.
9. PRINCIPAL OFFICE ADDRESS - FOREIGN DOMICILE STREET ADDRESS –
see Instructions
L025i
give the
physical or street address
(not a P. O. Box) of the foreign LLC required to be
maintained in its state of organization, or, if not so required, of the foreign LLC’s statutory agent in
its state or country of organization:
Attention (optional)
Address 1
Address 2 (optional)
City
Country
State or
Province
Zip
10. OPTIONAL – ARIZONA KNOWN PLACE OF BUSINESS ADDRESS:
10.1
Is the Arizona known place of business street address the same as the
street address
of the statutory agent?
Yes - go to the next page and continue.
No - complete number 10.2 and continue.
10.2
If you answered “no” to number 10.1, give the physical or street address (not a P.O.
Box) of the known place of business of the LLC in Arizona:
Attention (optional)
Address 1
Address 2 (optional)
City
Country
State or
Province
Zip
L025.001 Arizona Corporation Commission - Corporations Division
Rev: 2010 Page 2 of 3
COMPLETE NUMBER 11 OR NUMBER 12 – NOT BOTH.
11. MANAGER-MANAGED
LLC –
see Instructions L025i
check this box if management of
the LLC is vested in a manager or managers, and complete and attach the Manager Structure
Attachment form L040
. The filing will be rejected if it is submitted without the attachment.
12. MEMBER-MANAGED LLC –
check this box
if management of the
LLC is reserved to the members, and complete and attach the
Member Structure Attachment
form L041. The filing will be rejected if it is submitted without the attachment.
13. SIGNATURE:
I ACCEPT
Signature Printed Name Date
REQUIRED
– check only one and fill in the corresponding blank if signing for an entity
:
I am the individual Manager of this
manager-managed LLC or I am
signing for an entity manager
named:
I am a Member of this member-
managed LLC or I am signing for an
entity member named:
I am a duly authorized
agent for this LLC.
Filing Fee: $150.00 (regular processing)
Expedited processing – add $35.00 to filing fee.
All fees are nonrefundable - see Instructions.
Mail: Arizona Corporation Commission - Corporate Filings Section
1300 W. Washington St., Phoenix, Arizona 85007
Fax: 602-542-4100
Please be advised that A.C.C. forms reflect only the minimum provisions required by statute. You should seek private legal counsel for those matters that may pertain
to the individual needs of your business.
All documents filed with the Arizona Corporation Commission are public record and are open for public inspection.
If you have questions after reading the Instructions, please call 602-542-3026 or (within Arizona only) 800-345-5819.
L025.001 Arizona Corporation Commission - Corporations Division
Rev: 2010 Page 3 of 3
see Instructions L025i
By checking the box marked "I accept" below, I acknowledge under penalty
of perjury that this document together with any attachments is submitted in
compliance with Arizona law.