Business Entities Records - Information & Fees,order Form Page 2

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Secretary of State

Business Programs Division

Business Entities - Records, P.O. Box 944260, Sacramento, CA 94244-2600

Business Entities Records - Order Form

This request is being processed for:

(Please type or print legibly.)

Name:

_____________________________________________

Date:

___________________________

Address:

_____________________________________________

Phone #: ___________________________

City/State/Zip: _____________________________________________

Attn:

___________________________

If submitting in person (drop off only), select return method:

Mail Back

Pick Up

Entity Name: ____________________________________________________________________________________

CA Secretary of State Entity # (optional): ______________________

Entity Type:

Corporation

Limited Liability Company

Limited Partnership

General Partnership

Limited Liability Partnership

Other _______________________

(Specify other entity type)

Order Request:

(Check the applicable box(es) and complete the quantity desired.

Quantity

If requesting a copy, indicate if a plain (uncertified) or certified copy is requested

Copy of all documents .....................................................................................................

plain

certified [ ____ ]

Copy of formation (e.g., articles) or registration filing only ..............................................

plain

certified [ ____ ]

Copy of all amendments only

plain

certified [ ____ ]

(includes restated articles, mergers, dissolutions, cancellations, etc.)

Copy of last complete Statement of Information.............................................................

plain

certified [ ____ ]

Copy of last no change Statement of Information ..........................................................

plain

certified [ ____ ]

Copy of all Statements of Information of record ..............................................................

plain

certified [ ____ ]

Copy of _____________________________________________________________ .

plain

certified [ ____ ]

Certificate of Status

.......................................... [ ____ ]

(certifying to the status of the entity, e.g., active, suspended, cancelled, etc.)

Certificate of Filing of All Documents .................................................................................................................. [ ____ ]

Certificate of No Record....................................................................................................................................... [ ____ ]

Status report (computer printout of status and agent for service of process – cannot be certified) .................... [ ____ ]

Fax return of completed order (Fax #: _______________________________________ )

Secretary of State Use Only

Affix Cert & Seal _______________________

$ _________

Making first page

_____________________

$ _________

Making additional pages _________________

$ __________

Statement of Information ________________

$ _________