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Limited Liability Company Questionnaire ABC-256-LLC - California

Limited Liability Company Questionnaire Form. This is a California form and can be used in Department Of Alcoholic Beverage Control Statewide .
 Fillable pdf Last Modified 1/10/2011
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Department of Alcoholic Beverage Control LIMITED LIABILITY COMPANY QUESTIONNAIRE State of California Edmund G. Brown Jr., Governor Instructions: An individual managing member or designee may sign on behalf of the limited liability company. Attach a copy of original operating agreement and all amendments. 1. LIMITED LIABILITY COMPANY NAME 2. TELEPHONE NUMBER 3. PREMISES ADDRESS (Street number and name, city, zip code) 4. COMPANY HEADQUARTERS ADDRESS (Street number and name, city, state, zip code) 5. HEADQUARTERS TELEPHONE NUMBER 6. COMPANY ATTORNEY'S NAME 7. ATTORNEY'S TELEPHONE NUMBER 8. COMPANY ATTORNEY'S ADDRESS (Street number and name, city, state, zip code) 9. DATE LLC-1 FILED WITH SECRETARY OF STATE 10. STATE WHERE LLC-1 FILED WITH SECRETARY OF STATE 11. STATE WHERE LLC FORMED 12. ARTICLES OF ORGANIZATION (LLC-2 OR LLC-10) HAS BEEN AMENDED YES 13. OPERATING AGREEMENT DATE 14. LAST AMENDMENT DATE NO 15. The Limited Liability Company will be managed by (check one) One Manager 16. NAME OF MANAGER(S) MANAGER PRINTED NAME MANAGER PRINTED NAME More than one Manager Members Single Member MANAGER PRINTED NAME MANAGER PRINTED NAME 17. NAME OF OFFICERS AUTHORIZED BY ARTICLES OR AGREEMENT OFFICER PRINTED NAME OFFICER PRINTED NAME OFFICER PRINTED NAME OFFICER PRINTED NAME 18. LIST ALL MEMBERS MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE I hereby certify that the above are the present managers, officers, and members of the limited liability company and that each such manager, officer, and member is the real party in interest with respect to his or her position and is not acting, directly or indirectly as an agent, employee or representative of any other person not reported to the Department. The provisions of sections 23405.2 and 23405.3 of the Business and Professions Code are hereby acknowledged and it is understood that changes within the limited liability company and/or entities holding interest in the limited liability company will be reported to the Department as required. 19. SIGNATURE OF MANAGER OR DESIGNEE PRINTED NAME DATE SIGNED (Use reverse for additional names if needed) ABC-256-LLC (rev. 01-11) American LegalNet, Inc. www.FormsWorkFlow.com ADDITIONAL NAMES MEMBER'S PRINTED NAME (if needed) PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE MEMBER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE ABC-256-LLC (rev. 01-11) American LegalNet, Inc. www.FormsWorkFlow.com
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