LIMITED LIABILITY COMPANY STATEMENT OF ADDRESS CHANGE AND STATEMENT OF STATUTORY AGENT CHANGE Pursuant to A.R.S. §§ 29-605 and 29-605.01 FILING FEE $5.00 (A.R.S. § 29-851) THIS FORM IS NOT TO BE USED FOR ADDING MEMBERS – IF ADDING MEMBERS PLEASE USE THE AMENDMENT FORM It is important that the information you provide on this form be correct. To obtain the correct information about the Limited Liability Company’s current known place of business and statutory agent, consult the Customer Phone Bank at (602) 542-3026 or the Division’s website at www.azcc.gov/divisions/corporations. 1. The exact name of the Limited Liability Company (LLC) currently on file with the Arizona Corporation Commission (ACC) is: _______________________________________________________________________________ 2. The ACC file number is: ______________________________________ 3. The current address of the LLC’s known place of business on file with the ACC is: ______________________________________ ______________________________________ ______________________________________ 4. The name and street address* of the current statutory agent on file with the ACC are: ______________________________________ ______________________________________ ______________________________________ 5. If the LLC was not organized in Arizona, the address of the office required to be maintained in the state of its organization or, if not so required, of the principal office of the foreign LLC is: ______________________________________ ______________________________________ ______________________________________ 6. Is the known place of business in Arizona to be changed? No Yes and the address of the new place of business is: ______________________________________ ______________________________________ ______________________________________ * street address must be a physical address. P.O. Box addresses and personal mail boxes (PMB) will not be accepted. LL:0006 Rev. 10/2007 Page 1 of 3 Arizona Corporation Commission Corporations Division American LegalNet, Inc. www.FormsWorkflow.com LLC Name ______________________________________ ACC File Number __________________ 7. Is the street address of the current statutory agent to be changed? No. Yes, the new street address* of the current statutory agent is: ______________________________________ ______________________________________ ______________________________________ 8. Is a new statutory agent to be appointed? No. Yes. If you checked “yes”, you must complete the following information and the new statutory agent must accept his/her appointment (below). The new statutory agent is: ____________________________________________________________ New street address* of the statutory agent is: ______________________________________ ______________________________________ ______________________________________ Acceptance of Appointment By Statutory Agent The undersigned hereby acknowledges and accepts the appointment as statutory agent of the above-named limited liability company effective this ______ day of ____________, _______. Signature: _________________________________________________ Printed Name: ________________________Title:__________________ __________________________________________________________ If signing on behalf of a company, please print the company name here. 9. Is the address of one or more of the LLC’s members or managers to be changed? No. Yes. If you checked “yes”, you must complete the following information for each member or manager whose address is to be changed: Name: ____________________________________, Member or Manager (circle one) Current New Address: ________________________________ Address: _______________________________ ________________________________ _______________________________ ________________________________ _______________________________ LL:0006 Rev. 10/2007 Page 2 of 3 Arizona Corporation Commission Corporations Division American LegalNet, Inc. www.FormsWorkflow.com LLC Name ______________________________________ Name: ____________________________________, ACC File Number __________________ Member or Manager (circle one) Current New Address: ________________________________ Address: _______________________________ ________________________________ _______________________________ ________________________________ _______________________________ Name: ____________________________________, Member or Manager (circle one) Current New Address: ________________________________ Address: _______________________________ ________________________________ _______________________________ ________________________________ _______________________________ Name: ____________________________________, Member or Manager (circle one) Current New Address: ________________________________ Address: _______________________________ ________________________________ _______________________________ ________________________________ _______________________________ * street address must be a physical address. P.O. Box addresses and personal mail boxes (PMB) will not be accepted. Changes to the statutory agent address must be executed by the statutory agent. A.R.S §§29-605 and 29-605.01 requires that changes to limited liability companies (except for changes to the statutory agent’s address) be executed by a member/manager of the LLC. Dated this ______ day of ____________, _________ Dated this ______ day of ____________, _________ Signature: __________________________________ Signature: __________________________________ Printed Name: _______________________________ Printed Name: _______________________________ __________________________________________ Title: _______________________________________ If signing on behalf of a company, please print the company name here. LL:0006 Rev. 10/2007 Page 3 of 3 Arizona Corporation Commission Corporations Division American LegalNet, Inc. www.FormsWorkflow.com