Form Si-200 C - Statement Of Information (Domestic Stock And Agricultural Cooperative Corporations)

Download a blank fillable Form Si-200 C - Statement Of Information (Domestic Stock And Agricultural Cooperative Corporations) in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Si-200 C - Statement Of Information (Domestic Stock And Agricultural Cooperative Corporations) with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

State of California

Secretary of State

Statement of Information

(Domestic Stock and Agricultural Cooperative Corporations)

FEES (Filing and Disclosure): $25.00. If amendment, see instructions.

IMPORTANT – READ INSTRUCTIONS BEFORE COMPLETING THIS FORM

1. CORPORATE NAME

This Space for Filing Use Only

Due Date:

[For forms preprinted by the Secretary of State.]

Complete Addresses for the Following

(Do not abbreviate the name of the city. Items 2 and 3 cannot be P.O. Boxes.)

STREET ADDRESS OF PRINCIPAL EXECUTIVE OFFICE

CITY

STATE

ZIP CODE

STREET ADDRESS OF PRINCIPAL BUSINESS IN CALIFORNIA, IF ANY

CITY

STATE

ZIP CODE

MAILING ADDRESS OF THE CORPORATION, IF DIFFERENT THAN ITEM 2

CITY

STATE

ZIP CODE

Names and Complete Addresses of the Following Officers

(The corporation must list these three officers. A comparable title for the specific

officer may be added; however, the preprinted titles on this form must not be altered.)

CHIEF EXECUTIVE OFFICER/

ADDRESS

CITY

STATE

ZIP CODE

SECRETARY

ADDRESS

CITY

STATE

ZIP CODE

CHIEF FINANCIAL OFFICER/

ADDRESS

CITY

STATE

ZIP CODE

Names and Complete Addresses of All Directors, Including Directors Who are Also Officers

(The corporation must have at least one

director. Attach additional pages, if necessary.)

NAME

ADDRESS

CITY

STATE

ZIP CODE

NAME

ADDRESS

CITY

STATE

ZIP CODE

10. NAME

ADDRESS

CITY

STATE

ZIP CODE

11. NUMBER OF VACANCIES ON THE BOARD OF DIRECTORS, IF ANY:

Agent for Service of Process

(If the agent is an individual, the agent must reside in California and Item 13 must be completed with a California

street address (a P.O. Box is not acceptable). If the agent is another corporation, the agent must have on file with the California Secretary of State a

certificate pursuant to California Corporations Code section 1505 and Item 13 must be left blank.)

12. NAME OF AGENT FOR SERVICE OF PROCESS

[Note: The person designated as the corporation's agent MUST have agreed to act in that capacity prior to the designation.]

13. STREET ADDRESS OF AGENT FOR SERVICE OF PROCESS IN CALIFORNIA,

IF AN INDIVIDUAL

CITY

STATE

ZIP CODE

Type of Business

14. DESCRIBE THE TYPE OF BUSINESS OF THE CORPORATION

15. BY SUBMITTING THIS STATEMENT OF INFORMATION TO THE CALIFORNIA SECRETARY OF STATE, THE CORPORATION CERTIFIES THE INFORMATION

CONTAINED HEREIN, INCLUDING ANY ATTACHMENTS, IS TRUE AND CORRECT.