Form I-924 - Application For Regional Center Under The Immigrant Investor Pilot Program Page 5
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6Part 3. Information About the Regional Center (Continued)
8a. Describe and document the current and/or prospective structure of ownership and control of the commercial entity(s) in which the
EB-5 alien investors have or will make their capital investments.
b. Date commercial enterprise established, if any (mm/dd/yyyy):
c. Organization Structure for commercial enterprise:
1. Corporation
2. Partnership (including Limited Partnership)
3. Limited Liability Company (LLC)
4. Other (Explain)
d. Has or will the Regional Center or any of its principals or agents have an equity stake in the commercial enterprise?
No
Yes - Attach an explanation and documentation that outlines when and under what circumstances these remittances
will be paid.
e. Has or will the Regional Center or any of its principals or agents receive fees, profits, surcharges, or other like remittances
through EB-5 capital investment activities from this commercial enterprise, beyond the minimum capital investment threshold
required of the EB-5 alien entrepreneurs?
No
Yes - Attach an explanation and documentation that outlines when and under what circumstances these remittances
will be paid.
Part 4. Applicant Signature
Read the information on penalties in the instructions before completing this section. If
someone helped you prepare this petition, he or she must compete Part 5.
I certify, under penalty of perjury under the laws of the United States of America, that this form and the evidence submitted with it are
all true and correct. I authorize the release of any information from my records that U.S. Citizenship and Immigration Services needs
to determine eligibility for the benefit being sought. I also certify that I have authority to act on behalf of the Regional Center.
Signature of Applicant
Daytime Phone Number
Date (mm/dd/yyyy)
(Area/Country Codes)
Printed Name of Applicant
E-Mail Address
Relationship to the Regional Center Entity (Managing Member, President, CEO, etc.)
Form I-924 (11/23/10) Page 5
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