Vision Llc Resolution And Certificate Page 3
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Authorized Individual Information
_____________________________________________
____________________________________________
Authorized Individual Name
Title
_____________________________________________
____________________________________________
Date of Birth (MM/DD/YYYY)
Social Security Number or Taxpayer ID Number
_____________________________________________
____________________________________________
U.S. Drivers License Number
State of Issuance
Countries of Citizenship:
U.S.
Other (Indicate Countries): __________________________________________
Mailing Address
(If different than legal address)
_____________________________________________
____________________________________________
Address
City, State, Zip
_____________________________________________
(_____) ______ - _______ (_____) ______ - _______
Province (if applicable)
Country
Home Telephone
Work Telephone
Employment Status
_____________________________________________
____________________________________________
Employed
Not-Employed
Retired
Name of Employer
_____________________________________________
____________________________________________
Occupation (List source of income if retired or not employed)
Employer’s Address
_____________________________________________
____________________________________________
City, State, Zip
Province (if applicable), Country
LLC Resolution
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Parent category: Business