Form Abl-919 - Limited Liability Corporation (Llc) Supplemental Information Form printable pdf download

Form Abl-919 - Limited Liability Corporation (Llc) Supplemental Information Form

STATE OF SOUTH CAROLINA

1350

DEPARTMENT OF REVENUE

ABL-919

LIMITED LIABILITY CORPORATION (LLC)

(Rev. 2/29/12)

4378

SUPPLEMENTAL INFORMATION FORM

Check all boxes that apply and provide the requested information as requested herein:

Name of this LLC applying for permit and/or license:

This LLC is managed by its Members:

This LLC has an Operating Agreement, a copy of which is attached hereto, and each

Member is identified in the agreement.

This LLC does not have an Operating Agreement. Listed below is the name of every

Member that has an ownership interest in the LLC.

This LLC is managed by its Managers:

This LLC has an Operating Agreement, a copy of which is attached hereto, and each

Manager is identified in the agreement.

This LLC does not have an Operating Agreement. Listed below is the name of every

Manager of the LLC.

Percentage of

Name

Title

Ownership

, upon being first duly sworn, upon penalty of perjury,

do hereby acknowledge and affirm that the foregoing is true and correct and that all information

requested has been fully provided.

(L.S.)

Taxpayer's Signature

SWORN to and subscribed before me this

day of

, year of

Notary Public for

My Commission Expires:

Notary (L.S.)

Notary (printed name)

43781012

Form Abl-919 - Limited Liability Corporation (Llc) Supplemental Information Form