CFCVLR REV 03/2020
Arizona Corporation Commission – Corporations Division
Page 1 of 1
DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.
WHAT ARE YOU FILING?
Pick up
Name:
Mail
Name:
Address:
PAYMENT:
MOD Account #:
FOR ARIZONA CORPORATION COMMISSION USE ONLY
PICK-UP BY: _________________________________________________ DATE: ________________
View current processing times at:
http://azcc.gov/docs/default-source/corps-files/document-processing-times.pdf
Email
Phone number REQUIRED:
City:
State:
Zip:
YES - select 1 option below
NO - pay only the filing fee
New Entity Change to existing entity Re-submission of rejected filing
EXPEDITED PROCESSING?
ENTITY NAME - give the exact name of the entity as currently shown in A.C.C. records:
DOCUMENTS WILL BE MAILED IF THEY ARE NOT PICKED UP IN A TIMELY MANNER (APPROXIMATELY ONE WEEK)
Cash - do not mail cash. We do not accept bills over $20.00.
Cash may be used only for in-person submittals at the Phoenix office ONLY (Tucson does not accept cash).
Checks or money orders - must be made payable to "Arizona Corporation Commission," with all words spelled out and no
abbreviations. Checks must be completely and properly filled out, including the amount sections. UNACCEPTABLE CHECKS include: no imprinted
or preprinted name and address of the account holder; no imprinted or preprinted check number; handwritten or stamped names, addresses, or
check numbers; temporary checks (new accounts).
Credit cards - may be used for in-person submittals, and for online corporation annual reports, online name reservations, or online certificates
of good standing. We accept only Visa or MasterCard.
NOTE: A current phone number is required for ALL Same Day/Next Day services. Same Day/Next Day service will not guarantee approval of
submitted document(s) and only guarantees that the document(s) will be examined within the stated time frames. All fees are nonrefundable.
Document filing fees are listed on the bottom of each form or on the fee schedule on our website, http://ecorp.azcc.gov, under the FAQs.
Total amount to deduct:
REQUIRED - RETURN DELIVERY OPTION (PLEASE PRINT CLEARLY and select only ONE):
NOTE: PHONE NUMBER REQUIRED FOR ALL RETURN DELIVERY OPTIONS
Email address REQUIRED:
Phone number REQUIRED:
Phone number REQUIRED:
EXPEDITED PROCESSING, ADD $35.00
TWO-HOUR SERVICE, ADD $400.00
Document will be examined within 2-hours of submission
Must be received by 3:00pm MST
SAME DAY SERVICE, ADD $200.00
Document will be examined by 5:00pm MST and must
be received by 10:00am MST
NEXT DAY SERVICE, ADD $100.00
Document will be examined by 5:00pm MST on the
next business day. Must be received by 5:00pm MST
ARIZONA CORPORATION COMMISSION CORPORATIONS DIVISION
COVER SHEET
USE A SEPARATE COVER SHEET FOR EACH DOCUMENT
** ORDER COPIES USING A RECORDS REQUEST FORM **
** Note: For your convenience
the Records Request
Form M048.001 is included
in the next two pages.
DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.
RECORDS REQUEST FORM
USE ONE RECORDS REQUEST FORM FOR EACH ENTITY.
1. ENTITY NAME – give the exact name of the entity you want information on:
_____________________________________________________________________________________________
4. PAYMENT:
MOD Account #:
Cash - Do not mail cash. Cash may be used only for in-person submittals at the Phoenix office ONLY
(Tucson does not accept cash).
Checks or money orders - must be made payable to "Arizona Corporation Commission," with all words
spelled out and no abbreviations. Checks must be completely and properly filled out, including the amount
sections. UNACCEPTABLE CHECKS include: no imprinted or preprinted name and address of the account
holder; no imprinted or preprinted check number; handwritten or stamped names, addresses, or check
numbers; temporary checks (new accounts).
Credit cards - may be used for in-person submittals, and for online corporation annual reports, online
name reservations, or online certificates of good standing. We accept only Visa or MasterCard.
Pre-payment is required. Because the number of pages in older, microfilmed documents is not
readily determinable, we will accept checks written for "not to exceed" a certain amount, for example,
"not to exceed ten dollars and no cents." Submit payment with this Records Request Form.
Please note that the ability to satisfy the Same Day/Next Day time frames may be
dependent on the size or effort required of the records request.
2. PROCESSING TIME SELECTION:
3. FEES AND PAYMENT METHOD:
YES - select 1 option below
NO - pay only the filing fee
EXPEDITED PROCESSING?
NOTE: A current phone number is required for ALL Same Day/Next Day services. Same Day/Next Day service will not guarantee approval of
submitted document(s) and only guarantees that the document(s) will be examined within the stated time frames. All fees are nonrefundable.
Document filing fees are listed on the bottom of each form or on the fee schedule on our website, http://ecorp.azcc.gov, under the FAQs.
EXPEDITED PROCESSING, ADD $35.00
TWO-HOUR SERVICE, ADD $400.00
Document will be examined within 2-hours of submission
Must be received by 3:00pm MST
SAME DAY SERVICE, ADD $200.00
Document will be examined by 5:00pm MST and must
be received by 10:00am MST
NEXT DAY SERVICE, ADD $100.00
Document will be examined by 5:00pm MST on the
next business day. Must be received by 5:00pm MST
M048.007 Arizona Corporation Commission
Rev: 03/2024 Page 1 of 2 Corporations Division
FEES (A.R.S.
§§ 10-122, 10-3122, and 29-3213)
Archival Records Search - Stock search (not for copies of documents)
$5.00
Certified copy – corporations (per document) $5.00 + 50 cents per page
Certified copy – LLCs (per document) $15.00 + 50 cents per page
Certificate (any type that is not for copies) $10.00
Uncertified or plain copy – corporations (per document) 50 cents per page
Uncertified or plain copy – LLCs (per document) $5.00 + 50 cents per page
*Expedited processing is available by adding $35.00 to the fee for any request or service.
OPTIONAL: This two page Records Request Form M048.001 is only required if
you will be requesting copies of entity information as indicated in #6.
6. RECORDS OR SERVICE REQUESTED – check all boxes that apply to indicate what information you
want on the entity:
Archival records search - Stock search (this is a search for very old entities that generally do
not appear in A.C.C. computerized records - do not check this if you just want a copy of a
document - see above for copies.)
Certified copy of one or more documents - list the documents below (example - Articles of
Incorporation, all Amendments, Annual Report for year 2009) and put the quantity if you want
more than one copy of each:
______________________________________________________________________________________________
______________________________________________________________________________________________
Uncertified (plain) copy of documents - list the documents below (example - Articles of
Incorporation, Annual Report for year 2008) and put the quantity if you want more than one
copy of each:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
A Certificate (not for copies) - describe what you want the certificate to say, for example,
that a particular entity does not exist in A.C.C. records, or that certain entities merged.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Certificate of Good Standing
Please note that a "document" means all pages in A.C.C. records that are entered under one document
identification number. This means, for example, if you requested a copy of a merger, you will get the
Articles of Merger plus any and all other documents submitted with the Articles, because the entire
package is in A.C.C. records under one document id number and is considered to be one document.
M048.007 Arizona Corporation Commission
Rev: 03/2024
Page 2 of 2 Corporations Division
5. RETURN DELIVERY OPTIONS – check only one box to indicate how and to whom the item is to
Pick up
Name:
Phone:
Mail
Name:
Address:
Address 2 (optional):
City: State: Zip:
Country:
Phone:
Fax
Fax number:
Phone:
Attention:
be returned and complete the requested information:
Filing Fee: Will be determined by page count.
All fees are nonrefundable - see Instructions.
Please be advised that A.C.C. forms reflect only the minimum provisions required by statute. You should seek private legal counsel for those matters that may pertain
to the individual needs of your business. All documents filed with the Arizona Corporation Commission are public record and are open for public inspection.
If you have questions after reading the Instructions, please call 602-542-3026 or (within Arizona only) 800-345-5819.
Mail: Arizona Corporation Commission - Records Section
1300 W. Washington St., Phoenix, Arizona 85007
Records Section Fax: 602-542-3414
Email
Email address:
C018.004 Arizona Corporation Commission – Corporations Division
Rev: 6/2020
Page 1 of 4
DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.
APPLICATION FOR AUTHORITY
TO TRANSACT BUSINESS OR CONDUCT AFFAIRS IN ARIZONA
C018i
1. ENTITY TYPE – check only one to indicate the type of entity applying for authority:
FOR-PROFIT CORPORATION INSURER
NONPROFIT CORPORATION SAVINGS AND LOAN ASSOCIATION
PROFESSIONAL CORPORATION CREDIT UNION
CLOSE CORPORATION
COOPERATIVE MARKETING ASSOCIATION
ELECTRIC COOPERATIVE NON-PROFIT MEMBERSHIP ASSOC.
CORPORATION SOLE
NONPROFIT ELEC. GENERATION AND TRANSMISSION COOPERATIVE CORP.
2. NAME IN STATE OR COUNTRY OF INCORPORATION (FOREIGN NAME) – enter the exact, true name of the foreign
corporation:
__________________________________________________________________________________________________
3. NAME TO BE USED IN ARIZONA (ENTITY NAME) –
see Instructions C018i - identify the name the foreign corporation
will use in Arizona by checking 3.1, 3.2, or 3.3 (check only one), and follow instructions
3.1 Name in state or country
of incorporation, with no
changes –
Go to number 4.
3.2 Name in state or country of
incorporation, with a corporate
identifier added to it –
Enter the name in number 3.4
below
.
3.3 Fictitious name (check this
only if the foreign corporation’s
name in its state or country of
incorporation is not available for
use in Arizona) – Enter the name
in number 3.4 below.
3.4 If you checked 3.2 or 3.3, enter or print the name to be used in Arizona:
4. FOREIGN DOMICILE – list the state or country in which the foreign corporation is incorporated: _________________
5. DATE OF INCORPORATION IN FOREIGN DOMICILE: _________________________________________________
Read the Instructions
7. PURPOSE – the foreign corporation’s purpose is to engage in any or all lawful business or affairs in which corporations
may engage in the state or country under whose law the foreign corporation is incorporated, subject to the following
limitations, if any (leave this blank if there are no limitations on the corporation’s purpose):
6. DURATION
– if the duration or life period of the foreign corporation is perpetual (forever), then skip this
section and continue to number 7 or number 8. Otherwise, check the box below and fill in the date:
The foreign corporation life period will end on this date:
__________________
(enter a date)
C018.004 Arizona Corporation Commission – Corporations Division
Rev: 6/2020 Page 2 of 4
8. CHARACTER OF BUSINESS – briefly describe the character of business or affairs the foreign corporation initially
intends to conduct in Arizona. NOTE that the character of business or affairs that the foreign corporation ultimately
conducts is not limited by the description provided.
9. PRINCIPAL OFFICE ADDRESS - FOREIGN
DOMICILE STREET ADDRESS –
– give the physical or street address (not a P. O. Box)
of the foreign corporation required to be maintained in
its state or country of incorporation, or, if not so
required, of the foreign corporation’s statutory agent in
its state or country of incorporation:
10. ARIZONA KNOWN PLACE OF BUSINESS ADDRESS:
Is the Arizona known place of business street address the
same as the street address of the statutory agent?
Yes - go to number 11 and continue.
No - provide the Arizona physical or street
address (not a P.O. Box) below:
Attention (optional) Attention (optional)
Address 1 Address 1
Address 2 (optional)
City
State Zip
Address 2 (optional)
City State Zip
11. STATUTORY AGENT IN ARIZONA – see Instructions C018i:
11.1 REQUIRED – give the name (can be an
individual or an entity) and physical or street
address (not a P.O. Box) in Arizona of the
statutory agent:
11.2 OPTIONAL – mailing address in Arizona
of statutory agent (can be a P.O. Box):
Statutory Agent Name (required)
Attention (optional) Attention (optional)
Address 1 Address 1
Address 2 (optional)
City
State Zip
Address 2 (optional)
City State Zip
11.3 REQUIRED –
12. DIRECTORS - list the name and business address of each and every Director of the corporation. If more space is
needed, check this box and complete and attach the Director Attachment
form C082.
Director Name Director Name
Address 1 Address 1
Address 2 (optional) Address 2 (optional)
City
Country
State or
Province
Zip
City
Country
State or
Province
Zip
Date taking office (optional): Date taking office (optional):
see Instructions C018i
Authority.
the Statutory Agent Acceptance form M002 must be submitted along with this Application For
Capitol Corporate Services, Inc.
8825 N 23rd Ave., Ste. 100
Phoenix
AZ
85021
C018.004 Arizona Corporation Commission – Corporations Division
Rev: 6/2020 Page 3 of 4
Director Name Director Name
Address 1 Address 1
Address 2 (optional) Address 2 (optional)
City
Country
State or
Province
Zip
City
Country
State or
Province
Zip
Date taking office (optional): Date taking office (optional):
Director Name Director Name
Address 1 Address 1
Address 2 (optional) Address 2 (optional)
City
Country
State or
Province
Zip
City
Country
State or
Province
Zip
Date taking office (optional): Date taking office (optional):
13. OFFICERS - list the name and business address of all principal Officers of the corporation. If more space
is needed, check this box and complete and attach the Officer Attachment form C085.
Officer Name Officer Name
Address 1 Address 1
Address 2 (optional) Address 2 (optional)
City
Country
State or
Province
Zip City
Country
State or
Province
Zip
Date taking office (optional): Officer title: Date taking office (optional): Officer Title:
Officer Name Officer Name
Address 1 Address 1
Address 2 (optional) Address 2 (optional)
City
Country
State or
Province
Zip
City
Country
State or
Province
Zip
Date taking office (optional): Officer Title: Date taking office (optional) Officer Title:
Officer Name Officer Name
Address 1 Address 1
Address 2 (optional) Address 2 (optional)
City
Country
State or
Province
Zip
City
Country
State or
Province
Zip
Date taking office (optional): Officer Title: Date taking office (optional): Officer Title:
President
Vice President
Secretary
Treasurer
C018.004 Arizona Corporation Commission – Corporations Division
Rev: 6/2020 Page 4 of 4
14. FOR-PROFITS ONLY – SHARES AUTHORIZED –
see Instructions C018i – list the class (common, preferred, etc.) and
total number of shares the foreign corporation is AUTHORIZED to issue. This information must match the original Articles of
Incorporation plus any amendments thereto. If more space is needed, check this box and complete and attach the
Class: Series:
Total:
Class: Series: Total:
15. FOR-PROFITS ONLY – SHARES ISSUED – see Instructions C018i – list each class/series of authorized shares and give the
total number and par value of shares of that class that have been ISSUED. If no shares of that class have been issued, put
the number zero. If more space is needed, check this box
Class:
Series:
Total:
Class:
Series:
Total:
16. NONPROFITS ONLY – MEMBERS – check one box only:
Does the foreign nonprofit corporation have members?
Yes No
17. PROFESSIONAL CORPORATIONS ONLY – PROFESSIONAL SERVICES – if “professional corporation” is checked in
number 1, briefly describe the type of professional services the corporation will render (examples: accounting, medical,
law firm):
_______________________________________________________________________________________
18. PROFESSIONAL CORPORATIONS ONLY – PROFESSIONAL LICENSE:
By the signature appearing on this document, the foreign professional corporation certifies under penalty of law
that at least one-half of its shareholders who are entitled to vote for the election of directors, and at least one-half
of its directors, and its president, are licensed in one or more states to render a professional service described in
the foreign professional corporation’s articles of incorporation.
NOTE: You must attach a statement from the licensing authority in Arizona for the profession
showing that at least one of the professional corporation’s shareholders or employees is
licensed in Arizona to render that professional service. (See A.R.S.
§
10-2245.)
SIGNATURE:
I ACCEPT
Signature Printed Name Date
REQUIRED – check only one:
Filing Fee: $175.00 (regular processing)
All fees are nonrefundable - see Instructions.
Please be advised that A.C.C. forms reflect only the minimum provisions required by statute. You should seek private legal counsel for those matters that may pertain
to the individual needs of your business. All documents filed with the Arizona Corporation Commission are public record and are open for public inspection.
If you have questions after reading the Instructions, please call 602-542-3026 or (within Arizona only) 800-345-5819.
Shares Authorized Attachment form C087.
and complete and attach the Shares Issued Attachment
form
C097.
By checking the box marked "I accept" below, I acknowledge under penalty of law that this document
together with any attachments is submitted in compliance with Arizona law.
Expedited or Same Day/Next Day services are available for an additional fee – see Instructions or Cover sheet for prices.
I am the Chairman of the
Board of Director of the
corporation filing this document.
I am a duly-authorized Officer of
the corporation filing this
document.
I am a duly authorized Bankruptcy
trustee, receiver, or other court-
appointed fiduciary for the
corporation filing this document.
Mail: Arizona Corporation Commission - Examination Section
1300 W. Washington St., Phoenix, Arizona 85007
Fax (for Regular or Expedite Service ONLY): 602-542-4100
Fax (for Same Day/Next Day Service ONLY): 602-542-0900
For-Profits
Skip #16
C003.005 Arizona Corporation Commission – Corporations Division
Rev: 6/2020 Page 1 of 2
DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.
CERTIFICATE OF DISCLOSURE
1. ENTITY NAME
– give the exact name of the corporation in Arizona:
_______________________________________________________________
2. FELONY/JUDGMENT QUESTIONS
:
Has any person (a) who is currently an officer, director, trustee, or incorporator, or (b) who
controls or holds over ten percent of the issued and outstanding common shares or ten percent
2.1
Convicted of a felony involving a transaction in securities,
consumer fraud or antitrust in any state or federal jurisdiction
within the five-year period immediately preceding the signing of
this certificate?
Yes No
2.2
Yes No
2.3
Yes No
2.4
If any of the answers to numbers 2.1, 2.2, or 2.3 are
YES
, you
MUST
complete
and attach a form C004.
C003i
Read the Instructions
of any other proprietary, beneficial or membership interest in the corporation been:
Certificate of Disclosure Felony/Judgment Attachment
3. BANKRUPTCY QUESTION:
3.1
Has any person (a) who is currently an officer, director, trustee,
incorporator, or (b) who controls or holds over twenty percent of
the issued and outstanding common shares or twenty percent of
any other proprietary, beneficial or membership interest in the
corporation, served in any such capacity or held a twenty percent
interest in any other corporation (not the one filing this
Certificate) on the bankruptcy or receivership of the other
corporation ?
Yes No
3.2
If the answer to number 3.1 is
YES
, you
MUST
complete and attach a Certificate of
form C005.
Disclosure Bankruptcy Attachment
Convicted of a felony, the essential elements of which consisted
of fraud, misrepresentation, theft by false pretenses or restraint
of trade or monopoly in any state or federal jurisdiction within
the five-year period immediately preceding the signing of this
certificate?
Subject to an injunction, judgment, decree or permanent order
of any state or federal court entered within the five-year
period immediately preceding the signing of this certificate,
involving any of the following:
a.
b.
c.
The violation of fraud or registration provisions of
the securities laws of that jurisdiction;
The violation of the consumer fraud laws of that
jurisdiction;
The violation of the antitrust or restraint of trade
laws of that jurisdiction?
C003.005 Arizona Corporation Commission – Corporations Division
Rev: 6/2020 Page 2 of 2
IMPORTANT: If within 60 days of the delivery of this Certificate to the A.C.C. any person not included in this Certificate
becomes an officer, director, trustee or person controlling or holding over ten percent of the issued and outstanding
shares or ten percent of any other proprietary, beneficial or membership interest in the corporation, the corporation
must submit a SUPPLEMENTAL Certificate providing information about that person, signed by all incorporators or by a
duly elected and authorized officer.
SIGNATURE REQUIREMENTS:
Initial Certificate of Disclosure:
This Certificate must be signed by all incorporators. If more space is needed,
complete and attach an form C084.
Foreign corporations:
This Certificate may be signed by a duly authorized officer or by the Chairman of
the Board of Directors.
Credit Unions and Loan Companies:
This Certificate must be signed by any 2 officers or directors.
Name
Address 1
Address 2
City
Country
State
SIGNATURE – see Instructions C003i:
By typing or entering my name and checking the box marked
"I accept” below, I acknowledge under penalty of law that
this document together with any attachments is submitted in
compliance with Arizona law.
I ACCEPT
Signature
Printed Name Date
REQUIRED – check only one:
Incorporator - I am an incorporator of the
corporation submitting this Certificate.
Officer - I am an officer of the corporation
submitting this Certificate
Chairman of the Board of Directors - I am the
Chairman of the Board of Directors of the corporation
submitting this Certificate.
Director – I am a Director of the credit union or loan
company submitting this Certificate.
Name
Address 1
Address 2
City
Country
State
SIGNATURE – see Instructions C003i:
By typing or entering my name and checking the box marked
"I accept” below, I acknowledge under penalty of law that
this document together with any attachments is submitted in
compliance with Arizona law.
I ACCEPT
Signature
Printed Name Date
REQUIRED – check only one:
Incorporator - I am an incorporator of the
corporation submitting this Certificate.
Officer - I am an officer of the corporation
submitting this Certificate
Chairman of the Board of Directors - I am the
Chairman of the Board of Directors of the corporation
submitting this Certificate.
Director – I am a Director of the credit union or loan
company submitting this Certificate.
Filing Fee: None
All fees are nonrefundable - see Instructions.
Please be advised that A.C.C. forms reflect only the minimum provisions required by statute. You should seek private legal counsel for those matters that may pertain
to the individual needs of your business.
All documents filed with the Arizona Corporation Commission are public record and are open for public inspection.
If you have questions after reading the Instructions, please call 602-542-3026 or (within Arizona only) 800-345-5819.
ZipZip
Incorporator Attachment
Expedited or Same Day/Next Day services are available for an additional fee – see Instructions or Cover sheet for prices.
Mail: Arizona Corporation Commission - Examination Section
1300 W. Washington St., Phoenix, Arizona 85007
Fax (for Regular or Expedite Service ONLY): 602-542-4100
Fax (for Same Day/Next Day Service ONLY): 602-542-0900
M002.006
Arizona Corporation Commission – Corporations Division
Rev: 6/2020 Page 1 of 1
Please read Instructions
DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.
STATUTORY AGENT ACCEPTANCE
M002i
1. ENTITY NAME –
give the exact name in Arizona of the corporation or LLC that has appointed the
Statutory Agent (this must match exactly the name as listed on the document appointing the
statutory agent, e.g., Articles of Organization or Articles of Incorporation):
2.
STATUTORY AGENT NAME –
give the exact name of the Statutory Agent appointed by the
_____________________________________________________________________
By the signature appearing below, the individual or entity named in number 2 above
accepts the appointment as statutory agent for the entity named in number 1 above, and
acknowledges that the appointment is effective until the appointing entity replaces the statutory
agent or the statutory agent resigns, whichever occurs first.
Signature Printed Name Date
REQUIRED
– check only one
:
Individual as statutory agent:
I am
signing on behalf of myself as the individual
Entity as statutory agent:
I am signing on
behalf of the entity named as statutory agent,
and I am authorized to act for that entity.
Filing Fee: none (regular processing)
All fees are nonrefundable - see Instructions.
The person signing below declares and certifies under penalty of perjury that the information
contained within this document together with any attachments is true and correct, and is
submitted in compliance with Arizona law.
____________________________________________________________________________
entity listed in number 1 above (this will be either an individual or an entity). NOTE - the name
must match exactly the statutory agent name as listed in the document that appoints the
statutory agent (e.g. Articles of Incorporation or Articles of Organization), including any middle
initial or suffix:
3.
STATUTORY AGENT SIGNATURE:
(natural person) named as statutory agent.
Expedited services are available for an additional fee – see Instructions or Cover sheet for prices.
Mail: Arizona Corporation Commission - Examination Section
1300 W. Washington St., Phoenix, Arizona 85007
Fax: 602-542-4100
If you have questions after reading the Instructions, please call 602-542-3026 or (within Arizona only) 800-345-5819.
Please be advised that A.C.C. forms reflect only the minimum provisions required by statute. You should seek private legal counsel for those matters that may pertain
to the individual needs of your business. All documents filed with the Arizona Corporation Commission are public record and are open for public inspection.
Capitol Corporate Services, Inc.
Geneva Harrison, Asst. Secretary on
behalf of Capitol Corporate Services, Inc.
DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.
OFFICER ATTACHMENT
1. ENTITY NAME –
give the exact name of the corporation as currently shown in A.C.C. records:
______________________________________________________________________
2.
C085.002 Arizona Corporation Commission – Corporations Division
Rev: 7/2017 Page 1 of 1
Name currently shown in ACC records Name currently shown in ACC records
NEW Name NEW Name
Address 1 Address 1
Address 2 (optional) Address 2 (optional)
City State or
Province
Zip City State or
Province
Zip
Country Country
Date taking office (optional) Title Date taking office (optional)) Title
Address change Add officer Address change Add officer
Name change Remove officer Name change Remove officer
Name currently shown in ACC records Name currently shown in ACC records
NEW Name NEW Name
Address 1 Address 1
Address 2 (optional) Address 2 (optional)
City State or
Province
Zip City State or
Province
Zip
Country Country
Date taking office (optional) Title Date taking office (optional) Title
Address change Add officer Address change Add officer
Name change Remove officer Name change Remove officer
OFFICER CHANGE (CHANGE IN OFFICERS) –
Use one block per person -
To REMOVE an officer - list the name only of the officer being removed and check "Remove officer."
To ADD an officer - list the name and address of the officer being added and check "Add officer."
To CHANGE ADDRESS only - list the name and NEW address and check "Address change."
To CHANGE NAME of existing officer - list the current name, then the NEW name, and check "Name change."
If more space is needed, complete and attach another Officer Attachment form.
PROFIT/NON-PROFIT CORPORATION OPTIONAL ATTACHMENT
This page is an optional attachment. Use only if needed.
DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.
DIRECTOR ATTACHMENT
1. ENTITY NAME –
give the exact name of the corporation as currently shown in A.C.C. records:
_______________________________________________________________
2.
C082.003 Arizona Corporation Commission – Corporations Division
Rev: 3/2020 Page 1 of 1
DIRECTORS CHANGE (CHANGE IN DIRECTORS) – Use one block per person -
To REMOVE a director - list the name only of the director being removed and check "Remove director."
To ADD a director - list the name and address of the director being added and check "Add director."
To CHANGE ADDRESS only - list the name and NEW address and check "Address change."
To CHANGE NAME of existing director - list the current name, then the NEW name, and check "Name change."
If more space is needed, complete and attach another Director Attachment form C082.
Date taking office (optional):
Name Name
Address 1 Address 1
Address 2 (optional) Address 2 (optional)
City
Country
State or
Province
Zip City
Country
State or
Province
Zip
Date taking office (optional): Date taking office (optional):
Address change
Add as director
Name change
Remove director
Address change
Add as director
Name change
Remove director
Name
Address 1
Address 2 (optional)
City
Country
Date taking office (optional):
State or
Province
Zip
Name
Address 1
Address 2 (optional)
City
Country
State or
Province
Zip
Address change
Add as director
Remove director
Name change
Address change
Add as director
Remove director
Name change
PROFIT/NON-PROFIT CORPORATION OPTIONAL ATTACHMENT
This page is an optional attachment. Use only if needed.
C087.002
Arizona Corporation Commission – Corporations Division
Rev: 7/2017
Page 1 of 1
DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.
1. ENTITY NAME – give the exact name of the corporation:
______________________________________________________________________
2.
Class: Series: Total:
Class:
Series:
Class:
Total:
Class:
Series:
Class:
Series: Total:
Class:
Total:
Class:
Series:
Class: Series:
Series:
Series:
Total:
Total:
Total:
Total:
Additional classes and total number of shares AUTHORIZED:
SHARES AUTHORIZED ATTACHMENT
AUTHORIZED
PROFIT/NON-PROFIT CORPORATION OPTIONAL ATTACHMENT
This page is an optional attachment. Use only if needed.
C097.002
Arizona Corporation Commission – Corporations Division
Rev: 7/2017 Page 1 of 1
DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.
1. ENTITY NAME – give the exact name of the corporation:
______________________________________________________________________
2.
Additional classes and total number of shares ISSUED:
Class:
Series:
Total:
Class:
Series:
Class:
Series:
Class:
Total:
Class: Series:
Total:
Class:
Series:
Class:
Total:
Class:
Series:
Series:
Series:
Total:
Total:
Total:
Total:
SHARES ISSUED ATTACHMENT
ISSUED
PROFIT/NON-PROFIT CORPORATION OPTIONAL ATTACHMENT
This page is an optional attachment. Use only if needed.
