Form Si-200 C - Statement Of Information (Domestic Stock Corporation)
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1
2INSTRUCTIONS FOR COMPLETING FORM SI-200 C
For faster processing, the required statement for most corporations can be filed online at https://businessfilings.sos.ca.gov/.
Alternatively, statement forms are available on the Secretary of State’s website at and can be viewed,
filled in and printed from your computer. Completed forms along with the applicable fees can be mailed to Secretary of State,
Statement of Information Unit, P.O. Box 944230, Sacramento, CA 94244-2300 or delivered in person to the Sacramento office, 1500
th
rd
11
Street, 3
Floor, Sacramento, CA 95814. If you are not completing this form online, please type or legibly print in black or blue
ink. This form should not be altered.
Every domestic stock corporation shall file a Statement of Information with the Secretary of State, within 90 days after filing of its original
Articles of Incorporation, and annually thereafter during the applicable filing period. The applicable filing period for a corporation is the calendar
month during which its original Articles of Incorporation were filed and the immediately preceding five calendar months. A corporation is
required to file this statement even though it may not be actively engaged in business at the time this statement is due. Changes to information
contained in a previously filed statement can be made by filing a new form, completed in its entirety.
Statutory filing provisions are found in California Corporations Code
section
1502, unless otherwise indicated. Failure to file this Statement of
Information by the due date will result in the assessment of a $250.00 penalty. (Corporations Code
section
2204; Revenue and Taxation Code
section
19141)
FILING FEES: The initial or annual Statement of Information must be accompanied by a $20.00 filing fee and $5.00 disclosure fee. The filing
fee and the disclosure fee may be included in a single check made payable to the Secretary of State. All domestic stock corporations must
pay a total of $25.00 at the time of filing the initial or annual statement. If this statement is being filed to amend any information on a
previously filed statement and is being filed outside the applicable filing period, as defined above, no fee is required.
COPIES: The Secretary of State will endorse file one copy of the statement if an exact copy is submitted along with the statement to be filed.
Copies submitted with the statement to be filed can be certified upon request and payment of the $8.00 per copy certification fee.
PUBLICLY TRADED CORPORATIONS: Every publicly traded corporation must also file a Corporate Disclosure Statement
(Form
SI-PT)
annually, within 150 days after the end of its fiscal year.
Form SI-PT may be obtained from the Secretary of State’s website at
or by calling the Statement of Information Unit at (916) 657-5448.
A “publicly traded corporation” is a corporation, as defined in Corporations Code section 162, that is an issuer as defined in Section 3 of the
Securities Exchange Act of 1934, as amended (15 U.S.C. Sec. 78c), and has at least one class of securities listed or admitted for trading on a
national securities exchange, on the National or Small-Cap Markets of the NASDAQ Stock Market, on the OTC-Bulletin Board, or on the
electronic service operated by Pink Sheets, LLC.
Complete the Statement of Information (Form SI-200 C) as follows:
Item 1.
Please do not alter the preprinted name. If the corporate name is not correct, please attach a statement indicating the correct name
and the date the name change amendment was filed with the Secretary of State. If blank, enter the name of the corporation exactly
as it is of record with the California Secretary of State.
Item 2.
Enter the complete street address, city, state and zip code of the principal executive office. Please do not enter a P.O. Box or
abbreviate the name of the city. This address will be used for mailing purposes.
Item 3.
Enter the complete street address, city and zip code of the corporation's principal office in California, if any. Please do not enter a
P.O. Box or abbreviate the name of the city. Complete this item only if the address in Item 2 is outside of California.
Items
Enter the name and complete business or residential address of the corporation's chief executive officer (i.e., president), secretary
4-6.
and chief financial officer (i.e., treasurer). Please do not abbreviate the name of the city. The corporation must have these three
officers (Corporations Code
section
312(a).) An officer may hold more than one office. A comparable title for the specific officer may
be added; however, the preprinted titles on this form must not be altered.
Items
Enter the name and complete business or residential address of each incumbent director. If there are more than three directors,
7-9.
please attach additional pages. Please do not abbreviate the name of the city. The corporation must have at least one director.
(Corporations Code
section
212(a).)
Item 10. Enter the number of vacancies on the board of directors, if any.
Item 11. Enter the name of the agent for service of process in California. An agent is an individual (director, officer or any other person,
whether or not affiliated with the corporation) who resides in California or another corporation designated to accept service of process
if the corporation is sued. The agent must agree to accept service of process on behalf of the corporation prior to designation.
If another corporation is designated as agent, that corporation must have previously filed with the Secretary of State, a certificate
pursuant to Corporations Code
section
1505.
Note, a corporation cannot act as its own agent and no domestic or foreign
corporation may file pursuant to section 1505 unless the corporation is currently authorized to engage in business in California and is
in good standing on the records of the Secretary of State.
If an individual is designated as agent, complete Items 11 and 12. If a corporation is designated as agent, complete Item 11 and
proceed to Item 13 (do not complete Item 12).
Item 12. If an individual is designated as agent for service of process, enter a business or residential address in California. Please do not
enter “in care of” (c/o) or abbreviate the name of the city. Please do not enter an address if a corporation is designated as agent.
Item 13. Briefly describe the general type of business that constitutes the principal business activity of the corporation.
Item 14. Type or print the name and title of the person completing this form and enter the date this form was completed. 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.
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