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                            DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY. 

                 FOREIGN REGISTRATION STATEMENT
                                          Please read Instructions L025i 

1. ENTITY TYPE – check only one to indicate the type of entity applying for registration: 

                LIMITED LIABILITY COMPANY  PROFESSIONAL LIMITED LIABILITY COMPANY    SERIES LLC

2.  NAME IN STATE OR COUNTRY OF FORMATION (FOREIGN NAME) – enter the exact, true 
   name of the foreign LLC: 

   _____________________________________________________________________ 

3.  NAME TO BE USED IN ARIZONA (ENTITY NAME) – identify the name the foreign LLC will 
   use in Arizona by checking 3.1 or 3.2 (check only one), and follow instructions: 
   NOTE: For a foreign series LLC, "Series" must be included in the name.
   3.1         Name in state or country of formation, with no changes or additions – go to  
               number 4 and continue. 
   3.2         Fictitious name – check this if the foreign LLC’s name in its state or country of  
               formation is not available for use in Arizona or if that name does not contain an LLC  
               identifier, and enter the name in number 3.3 below.  NOTE –           a resolution of the  
               company adopting the fictitious name must be attached to and submitted with this 
               form.  
   3.3         If you checked 3.2, enter or print the name to be used in Arizona:  

               ______________________________________________________________

4.  PROFESSIONAL LIMITED LIABILITY COMPANY SERVICES – if professional LLC is checked 
   in number 1 above, describe the professional services that the professional LLC will provide 
   (examples: law firm, accounting, medical): 
   ______________________________________________________________________ 

5.   FOREIGN DOMICILE – list the state or country in 
   which the foreign LLC was formed: 

6.  DATE OF FORMATION IN FOREIGN DOMICILE:           ____________________________________ 

7.  PURPOSE OR GENERAL CHARACTER OF BUSINESS – describe or state the purpose of the 
   foreign LLC or the general character of the business it proposes to transact in Arizona:    
    _____________________________________________________________________________ 

L025.005                                                                                 Arizona Corporation Commission - Corporations Division 
Rev: 10/2020                                                                                                                                                                                            Page 1 of 4

8.   STATUTORY AGENT IN ARIZONA: 
     8.1      REQUIRED – give the name (can be                   8.2  REQUIRED - mailing address in Arizona of  
              an individual or an entity) and physical                statutory agent, if different from street address  
              or street address (not a P.O. Box) in Arizona               (can be a P.O. Box): 
              of the statutory agent:                                 Check box if same as street address.

Statutory Agent Name (required) 

Attention (optional)                                        Attention (optional) 

Address 1                                                   Address 1 

Address 2 (optional)                                        Address 2 (optional) 
City                                      State Zip         City                               State Zip 
     8.3    REQUIRED – the Statutory Agent Acceptance form M002 must be submitted along with 
               this Application For Registration. 

9.  PRINCIPAL MAILING ADDRESS - FOREIGN LLC – see Instructions L025i 
     Give the mailing address of the foreign LLC (not required to, but can be in Arizona and 
     may be a P.O. Box):

         Attention (optional) 

         Address 1 

         Address 2 (optional) 

         City                                               State or             Zip 
                                                            Province 
         Country 

10.  JURISDICTION OF FORMATION:

     10.1            Does the jurisdiction of formation require the LLC to maintain a street address
                     in that jurisdiction?
                                                     Yes   - complete number 10.2 and continue. 
                                                     No    - complete number 10.3 and continue. 

     10.2            If you answered “yes” to number 10.1, give the Foreign LLC street address in
                     jurisdiction of formation.

                     Attention (optional) 

                     Address 1 

                     Address 2 (optional) 

                     City                                             State or                 Zip 
                                                                      Province 
                     Country 

L025.005                                                                                                    Arizona Corporation Commission - Corporations Division   
Rev: 10/2020                                                                                                                                                                                                     Page 2 of 4

10.3         If you answered “no” to number 10.1, give the name and addresses of the statutory agent 
             in jurisdiction of formation of Foreign LLC.

             Statutory agent name: ________________________________________________ 

             Street address in jurisdiction of formation:

              Attention (optional) 

              Address 1 

              Address 2 (optional) 

              City                                        State or               Zip 
                                                          Province 
              Country 

             Mailing address in jurisdiction of formation:

              Attention (optional) 

              Address 1 

              Address 2 (optional) 

              City                                        State or               Zip 
                                                          Province 
              Country 

11.     INFORMATION REGARDING DESIGNATING FOREIGN COMPANY OF THE FOREIGN
         SERIES –  see Instructions L025i

         11.1   DESIGNATING FOREIGN COMPANY NAME IN JURISDICTION OF FORMATION
              (FOREIGN NAME) - enter the exact, true name of the Designating Foreign Company:

              _________________________________________________________________

         11.2 FOREIGN DOMICILE - list the jurisdiction in which the Designating Foreign Company
              was formed:

              _________________________________________________________________

         11.3 DATE OF FORMATION - list the date on which 
              the Designating Foreign Company was formed:

COMPLETE NUMBER 12 OR NUMBER 13 – NOT BOTH.

12.     MANAGER-MANAGED LLC – see Instructions L025i – check this box       if management of  
         the LLC is vested in a manager or managers, and complete and attach the Manager Structure 
         Attachment form L040.  The filing will be rejected if it is submitted without the attachment. 

13.     MEMBER-MANAGED LLC –       see Instructions L025i – check this box  if management of the  
         LLC is reserved to the members, and complete and attach the Member Structure Attachment
         form L041.  The filing will be rejected if it is submitted without the attachment.

L025.005                                                                                             Arizona Corporation Commission - Corporations Division   
Rev: 10/2020                                                                                                                                                                                          Page 3 of 4

14.     SIGNATURE:                             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.

                                                             I ACCEPT 

Signature                                                     Printed Name                                               Date 

REQUIRED – check only one and fill in the corresponding blank if signing for an entity: 

         I am an individual authorized to sign this document.              I am signing on behalf of an entity that is 
                                                                           authorized to sign this document.

Expedited or Same Day/Next Day services are available for an additional fee – see Instructions or Cover sheet for prices. 
Filing Fee:  $150.00 (regular processing)                     Mail:     Arizona Corporation Commission - Examination Section
                                                                          1300 W. Washington St., Phoenix, Arizona  85007 
All fees are nonrefundable - see Instructions.                Fax (for Regular or Expedite Service ONLY): 602-542-4100
                                                              Fax (for Same Day/Next Day Service ONLY): 602-542-0900
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. 

L025.005                                                                                                              Arizona Corporation Commission - Corporations Division   
Rev: 10/2020                                                                                                                                                                                                             Page 4 of 4