Fillable OFFICE OF THE ARIZONA ATTORNEY GENERAL C Must (Arizona Attorney General)

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OFFICE OF THE ARIZONA ATTORNEY GENERAL C Must (Arizona Attorney General)

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The OFFICE OF THE ARIZONA ATTORNEY GENERAL C Must (Arizona Attorney General) form is 2 pages long and contains:

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  • 7 check-boxes
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OFFICE OF THE ARIZONA ATTORNEY GENERAL
C
IVIL LITIGATION DIVISION
1 of 2
NOTICE OF CHANGE FORM
Must be submitted at least five (5) calendar days before the effective date of the change.
(Check the applicable box(es) for the change(s) being reported)
□
Ownership Change
□
Active Manager Change
□
Other Change(s)
Company Identifying Information
Name:
Participant Number:
Ownership Change
(Use a separate sheet if necessary)
List all individuals and entities who will own in the aggregate, directly or indirectly, 15% or more of the
Sandbox Participant after the impending change.
Full Name: __________________________________________________________________________
Address of primary residence (or principal place of business, if entity): __________________________
___________________________________________________________________________________
Date of birth (if individual): __________________
Jurisdiction of incorporation or formation (if entity): ________________________________________
Full Name: __________________________________________________________________________
Address of primary residence (or principal place of business, if entity): __________________________
___________________________________________________________________________________
Date of birth (if individual): __________________
Jurisdiction of incorporation or formation (if entity): ________________________________________
Full Name: __________________________________________________________________________
Address of primary residence (or principal place of business, if entity): __________________________
___________________________________________________________________________________
Date of birth (if individual): __________________
Jurisdiction of incorporation or formation (if entity): ________________________________________
List all individuals and entities previously owning 15% or more that will no longer have any ownership
interest in the company after the impending change.
Name:
Name:
OFFICE OF THE ARIZONA ATTORNEY GENERAL
C
IVIL LITIGATION DIVISION
2 of 2
Active Manager Change
(Use a separate sheet if necessary)
Full Name: ______________________________
If adding, also provide the following.
Title: ___________________________________
Brief description of duties:__________________
Address of primary residence: _______________
________________________________________
Date of birth: __________________
Add (A) or
Terminate (T)
(Check one)
A
□
T □
Effective Date of
Change:
Full Name: ______________________________
If adding, also provide the following.
Title: ___________________________________
Brief description of duties:__________________
Address of primary residence: _______________
________________________________________
Date of birth: __________________
Add (A) or
Terminate (T)
(Check one)
A
□
T □
Effective Date of
Change:
Other Change(s)
from the Original Application (or previous Notice of Change Form, as applicable)
Explanation:
Authorized Individual
I hereby certify that to the best of my knowledge, this Notice of Change Form contains no
misrepresentation or omissions of materials facts. (One of the Key Personnel on file with our office must
sign this form.)
Print Name:
Signature:
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OFFICE OF THE ARIZONA ATTORNEY GENERAL C Must (Arizona Attorney General)

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Completed 12 August 2020

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