Form Si-200 C - Statement Of Information (Domestic Stock Corporation) - 2003

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State of California

Kevin Shelley

Secretary of State

STATEMENT OF INFORMATION

)

(Domestic Stock Corporation

FEES (Filing and Disclosure): $25.00.

If amendment, see instructions.

IMPORTANT — READ INSTRUCTIONS BEFORE COMPLETING THIS FORM

CORPORATE NAME: (Please do not alter if name is preprinted.)

This Space For Filing Use Only

CALIFORNIA CORPORATE DISCLOSURE ACT

(Corporations Code section 1502)

CHECK HERE IF THE CORPORATION IS PUBLICLY TRADED.

IF PUBLICLY TRADED, COMPLETE THIS STATEMENT OF INFORMATION AND THE

CORPORATE DISCLOSURE STATEMENT (FORM SI-PTSUPP).

SEE ITEM 2 OF

INSTRUCTIONS.

COMPLETE ADDRESSES FOR THE FOLLOWING

(Do not abbreviate the name of the city. Items 3 and 4 cannot be PO Boxes.)

STREET ADDRESS OF PRINCIPAL EXECUTIVE OFFICE

CITY AND STATE

ZIP CODE

STREET ADDRESS OF PRINCIPAL BUSINESS OFFICE IN CALIFORNIA, IF ANY

CITY

STATE

ZIP CODE

MAILING ADDRESS

CITY AND STATE

ZIP CODE

NAMES AND COMPLETE ADDRESSES OF THE FOLLOWING OFFICERS

(The corporation must have these three officers. A comparable title for

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

CHIEF EXECUTIVE OFFICER/

ADDRESS

CITY AND STATE

ZIP CODE

SECRETARY/

ADDRESS

CITY AND STATE

ZIP CODE

CHIEF FINANCIAL OFFICER/

ADDRESS

CITY AND 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 AND STATE

ZIP CODE

10. NAME

ADDRESS

CITY AND STATE

ZIP CODE

11. NAME

ADDRESS

CITY AND STATE

ZIP CODE

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

AGENT FOR SERVICE OF PROCESS

• If an individual, the agent must reside in California and Item 14 must be completed with a California address.

•

If another corporation, the agent must have on file with the California Secretary of State a certificate pursuant to Corporations Code section 1505 and Item

14 must be left blank.

13. NAME OF AGENT FOR SERVICE OF PROCESS

14. ADDRESS OF AGENT FOR SERVICE OF PROCESS IN CALIFORNIA, IF AN INDIVIDUAL

CITY

STATE

ZIP CODE

TYPE OF BUSINESS

15. DESCRIBE THE TYPE OF BUSINESS OF THE CORPORATION

16. BY SUBMITTING THIS STATEMENT OF INFORMATION TO THE SECRETARY OF STATE, THE CORPORATION CERTIFIES THE INFORMATION CONTAINED HEREIN,

INCLUDING ANY ATTACHMENTS, IS TRUE AND CORRECT.

TYPE OR PRINT NAME OF OFFICER OR AGENT

SIGNATURE