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Arizona Corporation Statutory Agent Acceptance Form

Once a newly formed Arizona-based LLC has selected its statutory agent, it must notify the Secretary of State its decision by filing the completed version of this form with the Corporation Commission.Download

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M002.001                      Arizona Corporation Commission – Corporations Di\
vision 
Rev: 2010                                 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 appoin\
ted the 
Statutory Agent: 	
_______________________________________________________________________ \
	
2.  A.C.C. FILE NUMBER  (	if entity is already incorporated or registered in AZ	)
:__________________________ 	Find the A.C.C. file number on the upper corner of filed documents OR on\
 our website at: 
http://www.azcc.gov/Divisions/Corporations	
3.
STATUTORY AGENT NAME –  give
the exact name of the Statutory Agent appointed by the 
entity listed in number 1 above (this will be  either an individual or an entity): 
________________________________________________________________________\
_____ 
3.1   Check one box:	
 The statutory agent is an  Individual (natural person). 
 The statutory agent is an Entity. 
STATUTORY AGENT SIGNATURE :
By the signature appearing below, the individual or entity named in numb\
er 3 above  
accepts the appointment as statutory agent for the entity named in numbe\
r 1 above, and 
acknowledges that the appointment is effective until the entity replaces\
 the statutory agent or 
the statutory agent resigns, whichever occurs first. 	
 I ACCEPT 	
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) 
Expedited processing – add $35.00 to filing fee.  
All fees are nonrefundable - see Instructions.       Mail:     Arizona Corporation Commission - Corporate Filings Section 
            1300 W. Washington St., Phoenix, Arizona  85007 
Fax:      602-542-4100
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 602-54\
2-3026 or (within Arizona only) 800-345-5819.	
By checking the box marked "I accept" below, I acknowledge  under penalty of perjury that this 
document together with any attachments is submitted in compliance with A\
rizona law.
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