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1 T - 3 0 8 0 9 3 <br /> Attachment to <br /> LLCA 2A <br /> =�-3 � • $� Statement of Information attachment <br /> (Limited Liability Company) <br /> re�o�r <br /> A. Limited Liability Company Name <br /> Dycora Transitional Health -- Quail Lake LLC <br /> This Space For Office Use Only <br /> B. 12-Digit Secretary of State Fife Number C. State or Place of Organization(only if formed outside of California) <br /> 201630510290 <br /> D. list of Addition! Manager(s) or Members) - If the managerlmember is an individual, enter the individual's name and address. If the <br /> managertmember is an entity,enter the entity's name and address. Note: The LLC cannot serve as its own manager or member. <br /> 2a. First Name—Do not complete item 2b Middle Name Last Name suffix <br /> Julianne Williams LLC Mana er) <br /> 2b. Entity Name—Do not complete Item 2a <br /> 2c, Address City(no abbreviations) State Zip Code <br /> 1221 Rose Marie Lane Stockton I CA 195207 <br /> 3a. First Name—Do not complete Item 3b Middle Name Last Name Suffix <br /> 3b, Entity Name—Do not complete Item 3a <br /> 3c. Address City(no abbreviations) Ttate7 <br /> Code <br /> 4a First Name—Do not complete Item 4b Middle Name Last Name Suffix <br /> 4b Entity Name—Do not complete Item 4a <br /> 4c. Address City(no abbreviations) State Zip Code <br /> 5a, First Name—Do not complete Item 5b Middle Name Last Name Suffix <br /> 5b. Entity Name—Do not complete Item 5a <br /> 5c. Address City(no abbreviations) Stale Zip Code <br /> 6a, First Name—Do not complete Item 6b Middle Name Last Name Suffix <br /> 6b. Entity Name—Do not complete Item 6a <br /> 6c. Address City(no abbreviations) State Zip Code <br /> 7a. First Name—Do not complete Item 7b Middle Name Last Name Suffix <br /> 71b. Entity Name—Do not complete Item 7a <br /> 7c. Address City(no abbreviations) State Zip Code <br /> Be. First Name—Do not complete Item 8b Middle Name Last Name 771� <br /> 8b. Entity Name—Do not complete item Ba <br /> ac. Address City(no abbreviations) State Zip Code <br /> LLC-12A-Attachment(EST 0712016) j 2016 California Secretary of State <br /> // www.sos.ca.govibusinesslbe <br />