Department of Alcoholic Beverage Control
State of California
Gavin Newsom, Governor
LIMITED LIABILITY COMPANY QUESTIONNAIRE
Instructions: An individual managing member or designee may sign on behalf of the limited liability company.
Attach a copy of original operating agreement and all amendments.
1. LIMITED LIABILITY COMPANY NAME 2. TELEPHONE NUMBER
3. PREMISES ADDRESS (Street number and name, city, zip code)
4. COMPANY HEADQUARTERS ADDRESS (Street number and name, city, state, zip code) 5. HEADQUARTERS TELEPHONE NUMBER
6. COMPANY ATTORNEY'S NAME 7. ATTORNEY'S TELEPHONE NUMBER
8. COMPANY ATTORNEY'S ADDRESS (Street number and name, city, state, zip code)
9. DATE LLC-1 FILED WITH SECRETARY OF STATE 10. STATE WHERE LLC-1 FILED
WITH SECRETARY OF STATE
11. STATE WHERE LLC FORMED 12. ARTICLES OF ORGANIZATION
(LLC-2 OR LLC-10) HAS BEEN AMENDED
YES NO
13. OPERATING AGREEMENT DATE 14. LAST AMENDMENT DATE
15. The Limited Liability Company will be managed by (check one)
One Manager More than one Manager Members Single Member
16. NAME OF MANAGER(S)
MANAGER PRINTED NAME
MANAGER PRINTED NAME
MANAGER PRINTED NAME
MANAGER PRINTED NAME
17. NAME OF OFFICERS AUTHORIZED BY ARTICLES OR AGREEMENT
OFFICER PRINTED NAME
OFFICER PRINTED NAME
18. LIST ALL MEMBERS
OFFICER PRINTED NAME
OFFICER PRINTED NAME
MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE
MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE
MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE
MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE
MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE
I hereby certify that the above are the present managers, officers, and members of the limited liability company and that each such manager, officer, and
member is the real party in interest with respect to his or her position and is not acting, directly or indirectly as an agent, employee or representative of any
other person not reported to the Department. The provisions of sections 23405.2 and 23405.3 of the Business and Professions Code are hereby
acknowledged. It is understood that changes within the limited liability company and/or its entities holding interest in the limited liability company will be
reported to the Department and a fee may be required pursuant to Sections
24071.1 & 24072
B&P.
19. SIGNATURE OF MANAGER OR DESIGNEE PRINTED NAME DATE SIGNED
(Use reverse for additional names if needed)
ABC-256-LLC (rev. 07/19)
