SW3170701 - SMG Leasing LLC (6)

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J01. 112017 CA201611900010
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DENR-LAND QUALITY
sToLi�r�ER ASI TTY COMPANY ANNUAL REP
NAME OFUM17MUA91LOYCOMPANY: M -M T.VACYNG ASSOCIATES LIC
SOSID: 1103307
Date Filed: 9/19/2016 11:59:00 PM
Elaine F. Marshall
North Carolina Secretary of State
CA2016 119 00010
CA201611900010
CA201611
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SECRETARY OF STATE ID NUMBER: 1103307 STATE OF FORMATION: NC
REPORT FOR THE YEAR: 2016
® Changes ,
SECTION A: REGISTERED AGENTS INFORMATION .t..
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i. NAME OF REGISTERED AGENT, Ralph Z. Bentley, M.D.
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2. SIGNATURE OF THE NEW REGISTERED AGENT:
O WITURE CONSTMUTES CONSENT TO THE APPOINTMENT _
3. REGISTERED OFFICE STREET ADDRESS & COUNTY 4. REGISTERED OFFICE MAILING ADDRESS
208 Old Mockaville Road 206 Old Mackaville Road
Stateaville NO 28625
I>cedell Stataaville NC 26625
SECTION B: PRINCIPAL OFFICE INFORMATION
T. DESCRIPTION OF MATURE OF BUSINESS: ReAtai real estate
2. PRINCIPAI.,OFFICE PHONE NUMBER: 704-924-4283 3. PRINCIPAL OFFICE EMAIL:
4. PRINCIPALOFFICE STREET ADDRESS & COUNTY- S. PRINCIPAL OFFICE MAILING ADDRESS
129 Sherlock Drive PO SOX 1821
STATESVILLE DTC 28625 _
_ Isedell __ STATESVILI.F: NC 28687
SECTION C: COMPANY bFEALS (Enter additional Company Oris in Seetian E.)
NAME Dr. Neil Kassman NAME: Dr. Stm Stiwinski NAME: Dr. Ralph Bentley
Tmz Member TITLE: Member TfTLE: Member
ADDR.: 138 Columbine Drive ADDR,- 1126 Eufola Road AODR.: 332 N. Center Site
Statesville Statesville Statesyslle
KC 28625 ' NC 28677 NC 28677
SECTION 0: CERTIFICATION OF ANNUAL RF -PORTS Section D must be Completed in its enftty by a gG=mhu5R= 6nI11yl. _
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Form must be signed try a CcaTany On -;dal HOW ardor SOciion C of V& form.
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