Form Llc-12 - Statement Of Information - State Of California (2014)
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State of California
Secretary of State
STATEMENT OF INFORMATION
(Limited Liability Company)
Filing Fee $20.00. If this is an amendment, see instructions.
IMPORTANT — READ INSTRUCTIONS BEFORE COMPLETING THIS FORM
LIMITED LIABILITY COMPANY NAME
1.
This Space For Filing Use Only
File Number and State or Place of Organization
2.
SECRETARY OF STATE FILE NUMBER
3.
STATE OR PLACE OF ORGANIZATION (If formed outside of California)
No Change Statement
If there have been any changes to the information contained in the last Statement of Information filed with the California Secretary of
4.
State, or no Statement of Information has been previously filed, this form must be completed in its entirety.
If there has been no change in any of the information contained in the last Statement of Information filed with the California Secretary of
State, check the box and proceed to Item 15.
Complete Addresses for the Following
(Do not abbreviate the name of the city. Items 5 and 7 cannot be P.O. Boxes.)
5.
STREET ADDRESS OF PRINCIPAL OFFICE
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
6.
MAILING ADDRESS OF LLC, IF DIFFERENT THAN ITEM 5
7.
STREET ADDRESS OF CALIFORNIA OFFICE
CITY
STATE
ZIP CODE
CA
7.
EMAIL ADDRESS FOR RECEIVING STATUTORY NOTIFICATIONS
Name and Complete Address of the Chief Executive Officer, If Any
8.
NAME
ADDRESS
CITY
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.)
9.
NAME
ADDRESS
CITY
STATE
ZIP CODE
10. NAME
ADDRESS
CITY
STATE
ZIP CODE
11. NAME
ADDRESS
CITY
STATE
ZIP CODE
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 address, a
P.O. Box is not acceptable. If the agent is a 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
13. STREET ADDRESS OF AGENT FOR SERVICE OF PROCESS IN CALIFORNIA, IF AN INDIVIDUAL
CITY
STATE
ZIP CODE
CA
Type of Business
14. DESCRIBE THE TYPE OF BUSINESS OF THE LIMITED LIABILITY COMPANY
15. THE INFORMATION CONTAINED HEREIN, INCLUDING ANY ATTACHMENTS, IS TRUE AND CORRECT.
DATE
TYPE OR PRINT NAME OF PERSON COMPLETING THE FORM
TITLE
SIGNATURE
LLC-12 (REV 01/2014)
APPROVED BY SECRETARY OF STATE
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