Confidential Questionnaire for a Nevada Limited-Liability Company

Rushforth Lee & Kiefer LLP

1707 Village Center Circle, Suite 150, Las Vegas, NV 89134-0597

E-mail: office@rlklegal.com | Telephone: 702.255.4552. Fax: 702.255.4677

Limited-Liability Company (LLC).	☐-Standard | ☐-Series | ☐-Professional | ☐-Trust Company

Company (Fill in the fields to the right)	Name and Address of Company (include "LLC", "Ltd", etc.) Insert company name.	Telephone Company phone #.	Fax Company Fax #.
Contact Person(s) (Fill in the fields to the right)	Name and Address of Primary Contact(s) Who is/are our contact(s)?	Telephone Contact phone #.	E-mail address(s) E-mail address(s).
Registered Agent for Service of Process (Fill in the fields to the right)	Name and Address of Registered Agent for Service of Process Registered Agent name & address. -Contact person; -RLK	Address Where Records are Maintained Company records location. ☐-Same as agent | ☐-Same as company
Purpose and type of LLC (check all that apply):	☐-Operating trade or business; ☐ Investment holding/management company; ☐ For value-discounted gifts and/or inheritances; ☐ -Unlicensed family trust company; ☐-Licensed family trust company; ☐-For protection of LLC assets against judgments and other creditors’ claims against members; ☐-For protection of non-LLC assets against judgments and other creditors’ claims against company; ☐ Professional LLC; ☐-100% family owned; ☐-Other (Specify):

Members and Managers. (Use additional pages as needed. Check all applicable boxes under each name.)

Name	Residence or Business Address	Percentage
Name. ☐ Voting Member; ☐ Nonvoting; ☐ Manager	Address.	Enter %.
Name. ☐ Voting Member; ☐ Nonvoting; ☐ Manager	Address.	Enter %.
Name. ☐ Voting Member; ☐ Nonvoting; ☐ Manager	Address.	Enter %.

Additional Information. (Check the desired choice. Default choices in bold.)

Duration (Perpetual is Default) If not indefinite, specify # of years: # of Years.	If a series LLC is being created, make a list of members and managers for each series that is different from those listed in item 2, above.
Continuation	Upon death, retirement, resignation, expulsion, bankruptcy, etc. remaining members will have right to continue business unless you check here: ☐
Purpose	Enter purpose. If professional LLC, enter licensed profession. Except for professional LLC or trust company, “any lawful purpose” will be used if this is blank.
Management (Managers by Default) Check here ☐ for member managed	Admission of New Member (Majority Vote of Voting Members is default) Exception: [ ]-Unanimous vote; [ ]-Other (specify):
Designated Relative	(For family trust company only.)
Banking	Signatories: Who can sign checks? ☐-One signature required; ☐-Two signatories required; ☐-One signature if $__________ or less.
Taxation & Accountant	☒-Sole proprietor (1 member); ☐-Partnership; ☐-C corporation; ☐-S corporation. Name of CPA: CPA name.
Office Use Only: [ ] SS-4; [ ]-2553; [ ]-8832; [ ]-1023EIN: Tax Identification Number.

© Copyright 2017-2019 Rushforth Lee & Kiefer LLP	Version of March 9, 2019