form business

Secretary of State Business Programs Division 1500 11 Street, 3 Floor P.O. Box 944260 Sacramento, CA 94244-2600 th rd Certification and Records (916) 657-5448 BUSINESS ENTITIES RECORDS ORDER FORM To obtain information relating to a business entity of record with the Secretary of State, complete both pages of this order form, attach a check made payable to the Secretary of State for the appropriate amount or an amount “not to exceed” a specified amount written below the amount payable line, and submit your request: • By mail, along with a self-addressed envelope, to Secretary of State, Certification and Records, P.O. Box 944260, Sacramento, CA 94244-2600. Please refer to Business Entities Mail Processing Times for current mail processing times. In person, to the Secretary of State's Sacramento office at 1500 11th Street, 3rd Floor, Sacramento, CA 95814. Certificates of Status (for corporations in good standing) and status reports for corporations can be obtained over the counter at any of the Secretary of State's regional office locations. Please refer to Contact Information for regional office locations and addresses. A special handling fee of $10.00 per entity is applicable for any information requested over the counter except status reports. REQUESTOR’S INFORMATION Clear Information • YOUR NAME: FIRM NAME, IF ANY: ADDRESS: CITY/STATE/ZIP: PHONE #: FAX #: ENTITY NAME (If known, also include the entity file number.) Clear Entity Name ONLINE SEARCHES THE SPACE BELOW IS RESERVED FOR OFFICE USE ONLY Affix Cert. & Seal Making first page Making additional pages Certificate of Status Inquiry Statement of Information U.S. Fax Other Special Handling TOTAL AMOUNT DUE REFUND AMOUNT BALANCE DUE THIS SPACE FOR OFFICE USE ONLY Online access to certain business entity information is available as discussed below: $ $ $ $ $ $ $ $ $ $ $ $ • California Business Search: Allows you to view corporation, limited liability company and limited partnership information including the complete name of the entity, file number, date of formation or registration, status, jurisdiction, entity address, and name and address of the agent for service of process. • Publicly Traded Disclosure Search: Allows you to view abstracts of reported information for all publicly traded corporations that have filed a Corporate Disclosure Statement with the Secretary of State. TOTAL AMOUNT REC’D $ Email and/or online requests for copies, status information and/or certificates cannot be accepted at this time. Please complete both pages of this order form. BE - IRC ORDER FORM (REV 11/2008) Page 1 of 2 ENTITY NAME (If known, also include the entity file number.) Clear Entity Name ENTITY TYPE (Select the applicable entity type. CHECK ONLY ONE BOX.) CORPORATION (CORP) LIMITED LIABILITY COMPANY (LLC) LIMITED PARTNERSHIP GENERAL PARTNERSHIP LIMITED LIABILITY PARTNERSHIP OTHER Enter the other entity type. Clear Type COPY REQUESTS PLAIN (UNCERTIFIED) COPIES: $1.00 for the first page and $0.50 for each additional page; and CERTIFIED COPIES: $1.00 for the first page, $0.50 for each additional page AND $5.00 certification fee per document. Clear Copy If the number of pages is unknown when ordering copies, you may send either a check in the amount of $20.00 per entity (refunds will be issued for amounts over $5.00) or a blank check with a not to exceed amount written below the payment line (e.g., “NOT TO EXCEED $20.00”). A notice will be included with the order indicating the amount for which the check was completed. If the fees provided are insufficient, a fee letter indicating the total amount due will be sent to the requestor. The order will be completed upon receipt of the total fees. COPY OF ALL DOCUMENTS OF RECORD (e.g., initial filing, amendments, statements, etc.) ................ COPY OF INITIAL FORMATION/REGISTRATION DOCUMENT ......................................................... COPY OF ALL AMENDMENT DOCUMENTS ...................................................................................... COPY OF Enter the title of the document and, if known, the file date and/or document number. Plain Copies Certified Copies Certified Copies Certified Copies Certified Copies Plain Copies Plain Copies Plain Copies Plain Copies Plain Copies Plain Copies Plain Copies Plain Copies Plain Copies CORP & LLC ONLY: COPY OF ALL STATEMENT OF INFORMATION DOCUMENTS OF RECORD ........................................ COPY OF MOST RECENT STATEMENT OF INFORMATION (complete or no change) ................... COPY OF LAST COMPLETE STATEMENT OF INFORMATION ......................................................... COPY OF LAST NO CHANGE STATEMENT OF INFORMATION ...................................................... Certified Copies Certified Copies Certified Copies Certified Copies PUBLICLY TRADED CORP ONLY: COPY OF ALL CORPORATE DISCLOSURE STATEMENT DOCUMENTS OF RECORD ........................ COPY OF MOST RECENT CORPORATE DISCLOSURE STATEMENT ........................................... Certified Copies Certified Copies Please note: A “certified” copy of a Corporate Disclosure Statement filed prior to September 28, 2004 will include the Statement of Information that was filed together with that document. STATUS REPORTS – $4.00 Each Clear Reports Includes the complete entity name, file number, status, jurisdiction, and address(es); and when applicable, name and address of principal member/manager/officer, name and address of agent for service of process and type of business. STATUS REPORT ............................................................................................................................................................................ Report(s) Clear Certificates CERTIFICATES – $5.00 Each CERTIFICATE OF STATUS (certifying to the current status of the entity) ......................................................................................... CERTIFICATE OF FILING OF Enter the title of the document and, if known, the file date and/or document number. Certificate(s) Certificate(s) Certificate(s) Certificate(s) Clear Fax CERTIFICATE OF NO RECORD ..................................................................................................................................................... CERTIFICATE OF LISTING ($5.00 for each document listed) ....................................................................................................... FAX RETURN OF COPIES, STATUS REPORTS AND/OR CERTIFICATES DOMESTIC FAX (transmitted within the United States)............................................................................................................................... $ 5.00 per entity INTERNATIONAL FAX (transmitted outside the United States).......................................................................................................................... $10.00 per entity SPECIAL HANDLING – IN PERSON DELIVERY ONLY Clear Special SPECIAL HANDLING FEE (not applicable for orders submitted by mail) ............................................................................................... $10.00 per entity BE- IRC ORDER FORM (REV 11/2008) Page 2 of 2 Clear Form Print Form

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