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DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.
LLC STATEMENT OF CHANGE
OF MANAGER OR MEMBER ADDRESSES
Read the Instructions
L021i
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.
MANAGER ADDRESSES – for each manager being changed, list the name and address as currently shown on A.C.C. records
and then give the new address for that manager. If more space is needed, submit another Statement of Change form.
If the person is also a member, also list their name, address, and new address in the Member Addresses section.
NAME AND ADDRESS BEFORE CHANGES:
NEW ADDRESS ONLY:
Name 1
Address 1
Address 1
Address 2 (optional)
Address 2 (optional)
City
State
Zip
City
State
Zip
Country
Country
NAME AND ADDRESS BEFORE CHANGES:
NEW ADDRESS ONLY:
Name 2
Address 1
Address 1
Address 2 (optional)
Address 2 (optional)
City
State
Zip
City
State
Zip
Country
Country
NAME AND ADDRESS BEFORE CHANGES:
NEW ADDRESS ONLY:
Name 3
Address 1
Address 1
Address 2 (optional)
Address 2 (optional)
City
State
Zip
City
State
Zip
Country
Country
NAME AND ADDRESS BEFORE CHANGES:
NEW ADDRESS ONLY:
Name 4
Address 1
Address 1
Address 2 (optional)
Address 2 (optional)
City
State
Zip
City
State
Zip
Country
Country
L021.001
Arizona Corporation Commission – Corporations Division
Rev: 2010
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