Secretary of State
Business Programs Division
Business Entities, P.O. Box 944228, Sacramento, CA 94244-2280
Mail Submission Cover Sheet
Instructions:
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Submit this document with your filing. This information will be used to resolve questions with the filings
attached. This form will be treated as correspondence and will not be made part of the filed document.
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Make all checks payable to the Secretary of State.
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Do not include a $15 counter fee when submitting documents by mail.
Standard processing time for submissions to this office is approximately 5 business days from receipt. All
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submissions are reviewed in the date order of receipt. For updated processing time information, visit
Optional Copies and Certificates:
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A customer who submits documents with a filing fee of $25.00 or more will receive one (1) uncertified copy of the
documents for free and, at the time of filing, the free copy may be certified for a $5.00 certification fee.
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Customers requesting additional copies must include a $1.00 for the first page and $.50 for each additional page.
Each certified copy requires an additional $5.00 certification fee.
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At the time of filing, a Certificate of Status/Good Standing may be requested with a payment of a $5 fee.
Contact Person to resolve questions with this filing:
(Please type or print legibly)
First Name:
Last Name:
__________________________________________________
_______________________________________________
Phone:
______________________________________________________
Entity Information:
(Please type or print legibly)
Name:
__________________________________________________________________________________________________________________
Entity Number
:
(if applicable)
_____________________________________
Comments:
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
Return Address: For written communication from the Secretary of State related to this document, or if
purchasing a copy of the filed document enter the name of a person or company and the mailing address.
Name:
Company:
Secretary of State Use Only
Address:
T/TR:
AMT REC’D:
$
City/State/Zip:
Print Form
Doc Submission Cover - OBE (Est. 06/2016)
Clear Form