(435) 990-1339

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Cedar City, UT

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LLC State Renewal Questionnaire

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LLC State Renewal Questionnaire

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Company and Contact Information

Full Legal Entity Name(Required)

State of Registration Being Renewed(Required)

Registration Classification(Required)

Domestic (formed in this state)

Foreign (formed in another state)

Applies to the state selected above.

Client / Authorized Contact Name(Required)

Email Address(Required)

Phone Number

Entity Business Purpose(Required)

Principal Office Physical Street Address(Required)

Provide street, city, state, and ZIP. A physical street address is required; no P.O. Box.

Is the entity mailing address different from its principal address?(Required)

Yes

No

Entity Mailing Address (if different)(Required)

Include street or P.O. Box, city, state, and ZIP.

Owners, Officers, and Management

Members - Names, Addresses, and Membership Units(Required)

Member Full Name

Full Mailing Address

Membership Units

Use Add Row for each additional member.

Is this a manager-managed LLC?(Required)

Yes

No

Select Yes if managers are appointed to manage the LLC.

Managers - Names and Addresses(Required)

Manager Full Name

Full Mailing Address

Use Add Row for each manager.

If the entity is member-managed and has no separate managers, no manager list is required.

California - Additional Renewal Information

Only shown for California renewals.

California: Foreign LLC Principal Office Physical Street Address(Required)

California: Enrolled in EntityWise Mail Forward Program?(Required)

Yes

No

California: Domestic LLC Physical Street Address in California(Required)

If you have no California physical street address, contact your assigned paralegal.

Important: If you are not enrolled in Mail Forwarding and cannot supply a California physical street address, contact your assigned paralegal before submitting.

California: Does any member, manager, officer, or director have an outstanding final labor-code or wage-order judgment with no pending appeal?(Required)

Yes

No

Minnesota - Additional Renewal Information

Minnesota: Does the entity own, lease, or have a financial interest in agricultural land or land capable of being farmed?(Required)

Yes

No

Minnesota: Full-time Minnesota Employees (FTE)(Required)

Minnesota: Owner / Ownership Group Self-Identification (select all that apply)

Woman

Member of a community of color

Veteran

Member of a disability community

Member of an immigrant community

None of the above / prefer not to disclose

Optional self-identification. Becky should confirm whether the state requires any response.

Minnesota: Primary Revenue-Generating NAICS Sector(Required)

Minnesota: Full-Time or Part-Time Business Endeavor?(Required)

Full-time

Part-time

Minnesota: Gross Revenue for Prior Year

Use the prior year gross revenue range, if applicable.

New Jersey - Workers Compensation Insurance

New Jersey: Is this business qualified to provide self-insurance?(Required)

Yes

No

New Jersey: Workers Compensation Insurance Company(Required)

New Jersey: Workers Compensation Policy Number(Required)

New Jersey: Coverage Begin Date(Required)

MM slash DD slash YYYY

North Carolina - Veteran Status

North Carolina: Is the applicable owner a U.S. Veteran?(Required)

Yes

No

North Carolina: Is the veteran disabled?(Required)

Yes

No

Washington - Real Estate and Controlling Interests

Washington: Does the company own land, buildings, or other real property in Washington?(Required)

Yes

No

Washington: In the past 12 months, did any stock or other financial-interest transfer (or exercised option) result in a transfer of controlling interest?(Required)

Yes

No

Washington: In the past 12 months, has an option agreement been executed that would allow a future acquisition of controlling interest?(Required)

Yes

No

Washington notice: If your company owns land, buildings or other real estate in Washington, contact the Washington Department of Revenue regarding reportable controlling-interest transfers. Failure to report a transfer may be subject to penalties under RCW 82.45.220.

Wyoming - Asset Worksheet

Annual Report Appendix 1. Report only assets located and employed in Wyoming. Information supplied here can be sensitive.

Instructions: Report only assets located and employed in Wyoming, as of the appropriate financial period. Enter positive dollar amounts for allowances and accumulated amortization: the total calculation subtracts these lines. Assessed values, not ordinary book values, are required for certain property. Confirm calculations with EntityWise before filing.

Wyoming Line 1 - Cash(Required)

Please enter a number greater than or equal to 0.

Assets located and employed in Wyoming. Enter 0 if none.

Wyoming Line 2a - Trade Notes and Accounts Receivable(Required)

Please enter a number greater than or equal to 0.

Assets located and employed in Wyoming. Enter 0 if none.

Wyoming Line 2b - Allowance for Bad Debts (Deduction)(Required)

Please enter a number greater than or equal to 0.

Enter the positive deduction amount; it will be subtracted in the calculated total.

Wyoming Line 3 - Inventories(Required)

Please enter a number greater than or equal to 0.

Assets located and employed in Wyoming. Enter 0 if none.

Wyoming Line 4 - U.S. Government Obligations(Required)

Please enter a number greater than or equal to 0.

Assets located and employed in Wyoming. Enter 0 if none.

Wyoming Line 5 - Tax-Exempt Securities(Required)

Please enter a number greater than or equal to 0.

Assets located and employed in Wyoming. Enter 0 if none.

Wyoming Line 6 - Other Current Assets(Required)

Please enter a number greater than or equal to 0.

Assets located and employed in Wyoming. Enter 0 if none.

Wyoming Line 7 - Loans to Stockholders(Required)

Please enter a number greater than or equal to 0.

Assets located and employed in Wyoming. Enter 0 if none.

Wyoming Line 8 - Mortgage and Real Estate Loans Owned(Required)

Please enter a number greater than or equal to 0.

Loans and investments owned by the entity, not debts owed by the entity.

Wyoming Line 9 - Other Investments(Required)

Please enter a number greater than or equal to 0.

Assets located and employed in Wyoming. Enter 0 if none.

Wyoming Line 10 - Buildings and Other Depreciable Tangible Assets(Required)

Please enter a number greater than or equal to 0.

Use assessed valuation for assets having assessed value; do NOT deduct depreciation from assessed value. Use depreciated book value for unassessed assets.

Wyoming Line 11 - Depletable Assets(Required)

Please enter a number greater than or equal to 0.

Use assessed value of the gross product from the most recently ended fiscal year.

Wyoming Line 12 - Land(Required)

Please enter a number greater than or equal to 0.

Use assessed valuation of land.

Wyoming Line 13a - Intangible Assets(Required)

Please enter a number greater than or equal to 0.

Assets located and employed in Wyoming. Enter 0 if none.

Wyoming Line 13b - Accumulated Amortization (Deduction)(Required)

Please enter a number greater than or equal to 0.

Enter the positive deduction amount; it will be subtracted in the calculated total.

Wyoming Line 14 - Other Assets(Required)

Please enter a number greater than or equal to 0.

Assets located and employed in Wyoming. Enter 0 if none.

Wyoming Line 15 - Total Asset Value for License Tax

Calculated from lines 1-14. Confirm this amount before filing.

Wyoming worksheet notes: The provided worksheet states an annual report fee of $60 or 0.0002 × the reported asset value, whichever is greater. This is for reference only; EntityWise should verify the current official fee at filing time. Worksheet information is described as non-public by the supplied document, whereas figures reported on the state annual report may become public.

Final Review

Certification of Information(Required)

I certify that, to the best of my knowledge, the information entered is accurate and complete for the state renewal described above.

Additional Notes for EntityWise (optional)

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(435) 990-1339

entitywise@gmail.com

4363 W 1325 S Cedar City, UT 84720

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