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

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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

(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

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.)

STREET ADDRESS OF PRINCIPAL EXECUTIVE OFFICE

CITY AND STATE

ZIP CODE

CALIFORNIA OFFICE WHERE RECORDS ARE MAINTAINED (DOMESTIC ONLY)

CITY

STATE

ZIP CODE

NAME AND COMPLETE ADDRESS OF THE CHIEF EXECUTIVE OFFICER, IF ANY

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.)

NAME

ADDRESS

CITY AND STATE

ZIP CODE

NAME

ADDRESS

CITY AND STATE

ZIP CODE

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

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