Form Ll:0006 - Limited Liability Company Statement Of Address Change And Statement Of Statutory Agent Change Page 2
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3LLC Name ______________________________________
ACC File Number __________________
7. Is the street address of the current statutory agent to be changed?
No.
Yes, the new street address* of the current statutory agent is:
______________________________________
______________________________________
______________________________________
8. Is a new statutory agent to be appointed?
No.
Yes. If you checked “yes”, you must complete the following information and the new
statutory agent must accept his/her appointment (below).
The new statutory agent is: ____________________________________________________________
New street address* of the statutory agent is:
______________________________________
______________________________________
______________________________________
Acceptance of Appointment
By Statutory Agent
The undersigned hereby acknowledges and accepts the appointment as statutory agent of
the above-named limited liability company effective this ______ day of ____________, _______.
Signature: _________________________________________________
Printed Name: ________________________Title:__________________
__________________________________________________________
If signing on behalf of a company, please print the company name here.
9. Is the address of one or more of the LLC’s members or managers to be changed?
No.
Yes. If you checked “yes”, you must complete the following information for each
member or manager whose address is to be changed:
Name: ____________________________________,
Member or
Manager
(circle one)
Current
New
Address: ________________________________ Address: _______________________________
________________________________
_______________________________
________________________________
_______________________________
LL:0006
Arizona Corporation Commission
Rev. 10/2007
Corporations Division
Page 2 of 3
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