DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.
MANAGER STRUCTURE ATTACHMENT
1.
ENTITY NAME –
_______________________________________________________________________
2.
A.C.C. FILE NUMBER (if known):
Find the A.C.C. file number on the upper corner of filed documents OR on our website at: http://www.azcc.gov/Divisions/Corporations
3.
MANAGERS / MEMBERS –
Name Name
Address 1 Address 1
Address 2 (optional) Address 2 (optional)
City State or
Province
Zip City State or
Province
Zip
Country Country
20% or more member
20% or more member
20% or more member
20% or more member
Manager Less than 20% member Manager Less than 20% member
Name Name
Address 1 Address 1
Address 2 (optional) Address 2 (optional)
City State or
Province
Zip City State or
Province
Zip
Country Country
20% or more member
Manager Less than 20% member Manager Less than 20% member
Name Name
Address 1 Address 1
Address 2 (optional) Address 2 (optional)
City State or
Province
Zip City State or
Province
Zip
Country Country
20% or more member
Manager Less than 20% member Manager Less than 20% member
L040.002 Arizona Corporation Commission – Corporations Division
Rev: 2014 Page 1 of 1
Manager Structure Attachment form.
give the exact name of the LLC (foreign LLCs – give name in domicile state or country):
_________________________________________________
give the name and address of each and every manager and list all
members who own 20% or more of the profits or capital of the LLC. Use one block per
person. Members who own less than 20% may also be listed, but it is not required. Check the
appropriate box or boxes below each person listed - do not check both member boxes. If more
space is needed, use another
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