Form Rc-L-200b - License Application (Limited Liability Company) Page 10
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6: S
ART
IGNATURES
By signing below, each person certifies that the entire contents of this License Application
Form, including all supplementary statements and materials attached, are true and
correct, and that this application is not submitted with the intent to evade Chapter 10,
Title 32 of the Arizona Revised Statutes. A.R.S. § 32-1154(A)(9). It is a violation of A.R.S.
§ 32-1154(A)(5) to make a misrepresentation of a material fact in obtaining a license.
Applicant
The authorized representative listed in
Part 1: Applicant Information
must sign this application.
_____________________
_____________________
______________
Print Name
Signature
Date
Qualifying Party
The Qualifying Party listed under
Part 2: Qualifying Party
must sign this application.
_____________________
_____________________
______________
Print Name
Signature
Date
Persons
Every person listed under
Part 3: Persons
must sign this application. If you need additional space for
signatures, complete and attach additional signature pages with your application.
_____________________
_____________________
_____________________
Print Name
Signature
Date
_____________________
_____________________
_____________________
Print Name
Signature
Date
_____________________
_____________________
_____________________
Print Name
Signature
Date
_____________________
_____________________
_____________________
Print Name
Signature
Date
_____________________
_____________________
_____________________
Print Name
Signature
Date
1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ●
License Application (LLC)
Form RC-L-200B
Page 8 of 8
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