Limited Liability Company {L-LLC}

Page 1 of 2 Form L-LLC (0/201) LIMITED LIABILITY COMPANY L-LLC (0/201) This Limited Liability Company form should be completed for original applications or for changes of officers, managers, and members holding ownership in this business. This form is included in the Business Packet (L-B) for new applicants. License/Permit holders reporting changes use the Business Packet for Reporting Changes (L-BRC). For individuals outside the United States, not holding a social security number check the "Out of Country" box. For more inform ation contact your local TABC office or visit us at: www.tabc .texas.gov ENTITY INFORMATION 1. Fe deral Employer Identification Number (FEIN) 2. Business Entity Name 3. Filing Number 4.Member Managed or Manage r Managed Member Managed Manager Managed 5 . Date Filed (mm/dd/yyyy) State Class and Number of Memberships or Units Issued LIMITED LIABILITY COMPANY OWNERSHIP INFORMATION Officer Manager Member SSN Out of Country I ssuing State/DL No. Date of Birth (mm/dd/yyyy) Percent Membership or Units Held Last Name First Name MI Title Officer Manager Member SSN Out of Country Issuing State/DL No. Date of Birth (mm/dd/yyyy) Percent Membership or Units Held Last Name First Name MI Title Officer Manager Member SSN Out of Country Issuing State/DL No. Date of Birth (mm/dd/yyyy) Percent Membership or Units Held Last Name First Name MI Title Officer Manager Member SSN Out of Country Issuing State/DL No. Date of Birth (mm/dd/yyyy) Percent Membership or Units Held Last Name First Name MI Title American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Form L-LLC (0/201) LIMITED LIABILITY COMPANY OWNERSHIP INFORMATION CONTINUED Officer Manager Member SSN Out of Country Issuing State/DL No. Date of Birth (mm/dd/yyyy) Percent Membership or Units Held Last Name First Name MI Title Officer Manager Member SSN Out of Country Issuing State/DL No. Date of Birth (mm/dd/yyyy) Percent Membership or Units Held Last Name First Name MI Title Officer Manager Member SS N Out of Country Issuing State/DL No. Date of Birth (mm/dd/yyyy) Percent Membership or Units Held Last Name First Name MI Title Officer Manager Member SSN Out of Country Issuing State/DL No. Date of Birth (m m/dd/yyyy) Percent Membership or Units Held Last Name First N ame MI Title Officer Manager Member SSN Out of Country Issuing State/DL No. Date of Birth (mm/dd/yyyy) Percent Membership or Units Held Last Name First Name MI Title Officer Manager Member SSN Out of Country Issuing State/DL No. Date of Birth (mm/dd/yyyy) Percent Membership or Units Held Last Name First Name MI Title Officer Manager Member SSN Out of Country Issuing State/DL No. Date of Birth (mm/dd/yyyy) Percent Membership or Units Held Last Name First Name MI Title IF YOU NEED MORE SPA CE USE ADDITIONAL COPIES OF THIS PAGE American LegalNet, Inc. www.FormsWorkFlow.com