Form Llc-12 Statement Of Information (Limited Liability Company) - 2006

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L
State of California
Secretary of State
STATEMENT OF INFORMATION
(Limited Liability Company)
Filing Fee $20.00. If amendment, see instructions.
IMPORTANT — READ INSTRUCTIONS BEFORE COMPLETING THIS FORM
LIMITED LIABILITY COMPANY NAME
1.
(Please do not alter if name is preprinted.)
This Space For Filing Use Only
DUE DATE:
[For forms preprinted by the Secretary of State.]
FILE NUMBER AND STATE OR PLACE OF ORGANIZATION
2.
SECRETARY OF STATE FILE NUMBER
3. STATE OR PLACE OF ORGANIZATION
COMPLETE ADDRESSES FOR THE FOLLOWING
(Do not abbreviate the name of the city. Items 4 and 5 cannot be P.O. Boxes.)
4.
STREET ADDRESS OF PRINCIPAL EXECUTIVE OFFICE
CITY AND STATE
ZIP CODE
5.
CALIFORNIA OFFICE WHERE RECORDS ARE MAINTAINED (DOMESTIC ONLY)
CITY
STATE
ZIP CODE
CA
NAME AND COMPLETE ADDRESS OF THE CHIEF EXECUTIVE OFFICER, IF ANY
6.
NAME
ADDRESS
CITY AND STATE
ZIP CODE
NAME AND COMPLETE ADDRESS OF ANY MANAGER OR MANAGERS, OR IF NONE HAVE BEEN APPOINTED OR ELECTED,
PROVIDE THE NAME AND ADDRESS OF EACH MEMBER
(Attach additional pages, if necessary.)
7.
NAME
ADDRESS
CITY AND STATE
ZIP CODE
8.
NAME
ADDRESS
CITY AND STATE
ZIP CODE
9.
NAME
ADDRESS
CITY AND STATE
ZIP CODE
AGENT FOR SERVICE OF PROCESS (
If the agent is an individual, the agent must reside in California and Item 11 must be completed with a California
section
address. If the agent is a corporation, the agent must have on file with the California Secretary of State a certificate pursuant to Corporations Code
1505
and Item 11 must be left blank.)
10. NAME OF AGENT FOR SERVICE OF PROCESS
11. ADDRESS OF AGENT FOR SERVICE OF PROCESS IN CALIFORNIA, IF AN INDIVIDUAL
CITY
STATE
ZIP CODE
CA
TYPE OF BUSINESS
12. DESCRIBE THE TYPE OF BUSINESS OF THE LIMITED LIABILITY COMPANY
13. THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT.
TYPE OR PRINT NAME OF PERSON COMPLETING THE FORM
SIGNATURE
TITLE
DATE
LLC-12 (REV 07/2006)
APPROVED BY SECRETARY OF STATE
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