Form L032.001 - Statutory Agent Resignation - 2010

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DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.
STATUTORY AGENT RESIGNATION
LIMITED LIABILITY COMPANY
L032i
Read the Instructions
1.
ENTITY NAME – give the exact name of the LLC as currently shown in A.C.C. records:
__________________________________________________________________________________________________
2.
A.C.C. FILE NUMBER: _______________________________________________________________________________
Find the A.C.C. file number on the upper corner of filed documents OR on our website at:
3.
STATUTORY AGENT NAME – list the exact name of the resigning statutory agent as currently shown in A.C.C. records:
________________________________________________________________________________________________
4.
KNOWN PLACE OF BUSINESS ADDRESS – is the Arizona known place of business address for the LLC as currently
shown in A.C.C. records the same as the street address of the undersigned statutory agent?
Yes
No
4.1 If you answered yes to number 4, do you want to discontinue use of your address as the known place of business
for the LLC?
Yes
No
5.
NOTICE OF RESIGNATION – by the signature appearing below, the undersigned Statutory Agent certifies that written
notice of this resignation was mailed to the LLC at the following address:
Attention (optional)
Address 1
Address 2 (optional)
City
State or Province
Zip
Country
6.
STATEMENT OF RESIGNATION – by the signature appearing below, the statutory agent hereby resigns from the
appointment as statutory agent for the LLC named in number 1 above. The appointment as statutory agent terminates
(the resignation is effective) as of the thirty-first (31st) day after the date on which the Statutory Agent Resignation is
received by the Arizona Corporation Commission or upon appointment of a new statutory agent, whichever occurs first.
SIGNATURE:
By checking the box marked "I accept" below, I acknowledge under penalty of perjury that this document
together with any attachments is submitted in compliance with Arizona law.
I ACCEPT
Signature
Printed Name
Date
REQUIRED – check only one:
Individual as statutory agent: I am signing on behalf
Entity as statutory agent: I am signing on behalf of the
of myself as the individual (natural person) resigning as
entity resigning as statutory agent, and I am authorized to
statutory agent.
act for that entity.
Filing Fee: None (regular processing)
Mail:
Arizona Corporation Commission - Corporate Filings Section
Expedited processing – add $35.00 to filing fee.
1300 W. Washington St., Phoenix, Arizona 85007
All fees are nonrefundable - see Instructions.
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.
L032.001
Arizona Corporation Commission – Corporations Division
Rev: 2010
Page 1 of 1

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