Form Llc-12 Limited Liability Company - Statement Of Information - 1999
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1State of California
Bill Jones
Secretary of State
LIMITED LIABILITY COMPANY – STATEMENT OF INFORMATION
Filing Fee - Please see information section
IMPORTANT – Read Instructions Before Completing This Form
1.
LIMITED LIABILITY COMPANY NAME
This Space For Filing Use Only
2.
SECRETARY OF STATE FILE NUMBER
3.
JURISDICTION OF FORMATION
4.
STREET ADDRESS OF PRINCIPAL EXECUTIVE OFFICE
CITY AND STATE
ZIP CODE
5.
STREET ADDRESS IN CALIFORNIA OF OFFICE WHERE RECORDS ARE MAINTAINED (FOR DOMESTIC ONLY)
CITY
ZIP CODE
CA
6.
CHECK THE APPROPRIATE PROVISION BELOW AND NAME THE AGENT FOR SERVICE OF PROCESS:
[
] AN INDIVIDUAL RESIDING IN CALIFORNIA.
[
] A CORPORATION WHICH HAS FILED A CERTIFICATE PURSUANT TO SECTION 1505 OF THE CALIFORNIA CORPORATIONS CODE.
AGENT'S NAME:
7.
ADDRESS OF THE AGENT FOR SERVICE OF PROCESS IN CALIFORNIA, IF AN INDIVIDUAL
CITY
ZIP CODE
CA
8.
DESCRIBE TYPE OF BUSINESS OF THE LIMITED LIABILITY COMPANY.
LIST THE 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 AND CHIEF EXECUTIVE OFFICER (CEO), IF ANY. (CHECK THE APPROPRIATE
DESIGNATION). ATTACH ADDITIONAL PAGES IF NECESSARY.
9.
NAME
[
] MANAGER
ADDRESS
[
] MEMBER
CITY
STATE
ZIP
[
] CEO, IF ANY
10.
NAME
[
] MANAGER
ADDRESS
[
] MEMBER
CITY
STATE
ZIP
[
] CEO, IF ANY
11.
NUMBER OF PAGES ATTACHED, IF ANY.
12.
I DECLARE THAT THIS STATEMENT IS TRUE, CORRECT, AND COMPLETE.
SIGNATURE OF INDIVIDUAL AUTHORIZED TO SIGN
DATE
TYPE OR PRINT NAME AND TITLE OF PERSON SIGNING
DUE DATE:
SEC/STATE FORM LLC-12 (REV. 11/99)
APPROVED BY SECRETARY OF STATE
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