Certificate Of Disclosure Bankruptcy Attachment
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DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.
CERTIFICATE OF DISCLOSURE
BANKRUPTCY ATTACHMENT
Read the Instructions
C005i
1.
ENTITY NAME – give the exact name of the corporation in Arizona:
_______________________________________________________________________
2.
A.C.C. FILE NUMBER (if already incorporated or registered in AZ): ________________________
Find the A.C.C. file number on the upper corner of filed documents OR on our website at:
3.
Check one box only to indicate the document the Attachment goes with:
Attachment to Certificate of Disclosure signed on this date: _____________________.
Attachment to Annual Report due on this date: ________________________.
4.
If you answered YES to the Bankruptcy question on the Certificate of Disclosure form or to
question 15 on the Annual Report, you MUST provide the following information for each
“other corporation” (complete a new Attachment for additional corporations):
4.1
Name and address of each “other corporation,” state or states in which each “other
corporation” (a) was incorporated and (b) transacted business, dates of corporate
operation, and name and address of each individual involved:
First “other corporation”
Name of other corporation 1
Name of Individual 1
Address 1
Address 1
Address 2 (optional)
Address 2 (optional)
City
State
City
State
Zip
Zip
Country
Country
State(s) of Incorporation:
Name of Individual 2
State(s) of transaction of business:
Address 1
Address 2 (optional)
Dates of corporation operation:
City
Zip
State
Country
C005.001
Arizona Corporation Commission – Corporations Division
Rev: 2010
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