Fillable Form 1.: FOREIGN REGISTRATION STATEMENT (Arizona Corporation Commission)

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Form 1.: FOREIGN REGISTRATION STATEMENT (Arizona Corporation Commission)

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DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.
FOREIGN REGISTRATION STATEMENT
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
______________________________________________________________________
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:
_____________________________________________________________________________
L025.004 Arizona Corporation Commission - Corporations Division
Rev: 3/2020
Page 1 of 4
______________________________________________________________
SERIES LLC
NOTE: For a foreign series LLC, "Series" must be included in the name.
which the foreign LLC was formed:
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
REQUIRED -
mailing 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 MAILING ADDRESS - FOREIGN LLC –
Give the mailing address of the foreign LLC (not required to, but can be in Arizona and
may be a P.O. Box):
10. JURISDICTION OF FORMATION:
10.1 Does the jurisdiction of formation require the LLC to maintain a street address
Yes - complete number 10.2 and continue.
No - complete number 10.3 and continue.
10.2
If you answered “yes” to number 10.1, give the Foreign LLC street address in
jurisdiction of formation.
Attention (optional)
Address 1
Address 2 (optional)
City
Country
State or
Province
Zip
L025.004 Arizona Corporation Commission - Corporations Division
Rev: 3/2020
Page 2 of 4
see Instructions L025i
in that jurisdiction?
Attention (optional)
Address 1
Address 2 (optional)
City
Country
State or
Province
Zip
Check box if same as street address.
12. 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.
13. 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.
L025.004 Arizona Corporation Commission - Corporations Division
Rev: 3/2020
Page 3 of 4
see Instructions L025i
10.3
If you answered “no” to number 10.1, give the name and addresses of the statutory agent
in jurisdiction of formation of Foreign LLC.
Attention (optional)
Address 1
Address 2 (optional)
City
Country
State or
Province
Zip
Street address in jurisdiction of formation:
Mailing address in jurisdiction of formation:
Attention (optional)
Address 1
Address 2 (optional)
City
Country
State or
Province
Zip
Statutory agent name:
________________________________________________
11. INFORMATION REGARDING DESIGNATING FOREIGN COMPANY OF THE FOREIGN
SERIES
–
see Instructions L025i
11.1 DESIGNATING FOREIGN COMPANY NAME IN JURISDICTION OF FORMATION
11.2
FOREIGN DOMICILE - list the jurisdiction in which the Designating Foreign Company
was formed:
(FOREIGN NAME) - enter the exact, true name of the Designating Foreign Company:
_________________________________________________________________
_________________________________________________________________
11.3
DATE OF FORMATION - list the date on which
the Designating Foreign Company was formed:
COMPLETE NUMBER 12 OR NUMBER 13 – NOT BOTH.
14. SIGNATURE:
I ACCEPT
Signature Printed Name Date
REQUIRED
– check only one and fill in the corresponding blank if signing for an entity
:
Filing Fee: $150.00 (regular processing)
All fees are nonrefundable - see Instructions.
Mail: Arizona Corporation Commission - Examination 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.
By checking the box marked "I accept" below, I acknowledge under penalty
of law that this document together with any attachments is submitted in
compliance with Arizona law.
L025.004 Arizona Corporation Commission - Corporations Division
Rev: 9/2020
Page 4 of 4
I am an individual authorized to sign this document.
I am signing on behalf of an entity that is
authorized to sign this document.
Expedited or Same Day/Next Day services are available for an additional fee – see Instructions or Cover sheet for prices.
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Form 1.: FOREIGN REGISTRATION STATEMENT (Arizona Corporation Commission)

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Completed 7 May 2021

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