Attachment to
LLC-12A
Statement of Information
Attachment
(Limited Liability Company)
A
. Limited Liability Company Name
This Space For Office Use Only
B.
12-Digit Secretary of State File Number
C.
State or Place of Organization (only if formed outside of California)
D. List of Additional Manager(s) or Member(s) - If the manager/member is an individual, enter the individual’s name and address.
If the
manager/member is an entity, enter the entity’s name and address. Note: The LLC cannot serve as its own manager or member.
2a.
First Name – Do not complete Item 2b
Middle Name
Last Name
Suffix
2b. Entity Name – Do not complete Item 2a
2c.
Address
City (no abbreviations)
State
Zip Code
3a.
First Name – Do not complete Item 3b
Middle Name
Last Name
Suffix
3b. Entity Name – Do not complete Item 3a
3c.
Address
City (no abbreviations)
State
Zip Code
4a.
First Name – Do not complete Item 4b
Middle Name
Last Name
Suffix
4b. Entity Name – Do not complete Item 4a
4c.
Address
City (no abbreviations)
State
Zip Code
5a.
First Name – Do not complete Item 5b
Middle Name
Last Name
Suffix
5b. Entity Name – Do not complete Item 5a
5c.
Address
City (no abbreviations)
State
Zip Code
6a. First Name – Do not complete Item 6b
Middle Name
Last Name
Suffix
6b. Entity Name – Do not complete Item 6a
6c.
Address
City (no abbreviations)
State
Zip Code
7a. First Name – Do not complete Item 7b
Middle Name
Last Name
Suffix
7b. Entity Name – Do not complete Item 7a
7c.
Address
City (no abbreviations)
State
Zip Code
8a. First Name – Do not complete Item 8b
Middle Name
Last Name
Suffix
8b. Entity Name – Do not complete Item 8a
8c.
Address
City (no abbreviations)
State
Zip Code
Attachment
2016 California Secretary of State
LLC-12A -
(EST 07/2016)
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