Form 08-435 - Information On Registering A Limited Liability Company Page 2
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213. If member managed, the names and addresses of the LLC’s members:
Attach list of additional names if necessary.
14. The names, addresses, and percentage of interest held in the LLC by each person owning
5% or more of the interest in the LLC:
Attach list of additional names if necessary.
Signed this
day of
,
.
Signature
Printed Name and Title
Mailing Address
__________________
______________________
______________________________
__________________
______________________
______________________________
__________________
______________________
______________________________
__________________
______________________
______________________________
__________________
______________________
______________________________
* This application must be accompanied by an original Certificate of Good Standing (Compliance) from the
state where the LLC was organized.
08-435 (Rev. 7/99)
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