Form Si-550 - Statement Of Information
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1Secretary of State
SI-550
Statement of Information
(California Stock, Agricultural
Cooperative and Foreign Corporations)
IMPORTANT —
Read instructions
before completing this form.
Fees (Filing plus Disclosure) – $25.00;
Copy Fees – First page $1.00; each attachment page $0.50;
Certification Fee - $5.00 plus copy fees
1. Corporation Name
(Enter the exact name of the corporation as it is recorded with the California
This Space For Office Use Only
Secretary of State. Note: If you registered in California using an assumed name,
see
instructions.)
2. 7-Digit Secretary of State File Number
3. Business Addresses
a. Street Address of Principal Executive Office - Do not list a P.O. Box
City (no abbreviations)
State
Zip Code
b. Mailing Address of Corporation, if different than item 3a
City (no abbreviations)
State
Zip Code
c. Street Address of Principal California Office, if any and if different than Item 3a - Do not list a P.O. Box
City (no abbreviations)
State
Zip Code
CA
The Corporation is required to list all three of the officers set forth below. An additional title for the Chief Executive Officer and Chief
4. Officers
Financial Officer may be added; however, the preprinted titles on this form must not be altered.
a. Chief Executive Officer/
First Name
Middle Name
Last Name
Suffix
Address
City (no abbreviations)
State
Zip Code
b. Secretary
First Name
Middle Name
Last Name
Suffix
Address
City (no abbreviations)
State
Zip Code
c. Chief Financial Officer/
First Name
Middle Name
Last Name
Suffix
Address
City (no abbreviations)
State
Zip Code
California Stock and Agricultural Cooperative Corporations ONLY: Item 5a: At least one name and address must be listed. If the
5. Director(s)
Corporation has additional directors, enter the name(s) and addresses on Form SI-550A
(see
instructions).
a. First Name
Middle Name
Last Name
Suffix
Address
City (no abbreviations)
State
Zip Code
b. Number of Vacancies on the Board of Directors, if any
6. Service of Process
(Must provide either Individual OR Corporation.)
INDIVIDUAL – Complete Items 6a and 6b only. Must include agent’s full name and California street address.
a. California Agent's First Name (if agent is not a corporation)
Middle Name
Last Name
Suffix
b. Street Address (if agent is not a corporation) - Do not enter a P.O. Box
City (no abbreviations)
State
Zip Code
CA
CORPORATION – Complete Item 6c only. Only include the name of the registered agent Corporation.
c. California Registered Corporate Agent’s Name (if agent is a corporation) – Do not complete Item 6a or 6b
7. Type of Business
Describe the type of business or services of the Corporation
8. The Information contained herein, including in any attachments, is true and correct.
______________________
_____________________________________________________________
________________________
___________________________________
Date
Type or Print Name of Person Completing the Form
Title
Signature
2017 California Secretary of State
SI-550 (REV 01/2017)
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