California LLC Statement of Information Form

Once an LLC receives the copies of its Articles of Organization from California’s Secretary of State, the official agent must accomplish this form and submit it to the SOS’ office within 90 days of receipt.Download

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SB 1532 - Business Entities Filings (Rev. 11/21/2012) 
 
 	
Changes to California Business Entity Filings effective January 1, 2013 \
 	
As of January 1, 2013, new legal requirements appl y to business entity documents filed with the 
California Secretary of State’s office.  
 
Entity and Agent Addresses   
All formation/registration documents must incl ude the business entity street address and mailing 
address.   
 
All foreign corporation and foreign limited liability company registration documents must 
include the street address of the principal business office address in California, if one exists. 
 
All documents listing an individual person as an  agent for service of process must include the 
agent’s California street address.  All corporat e agents filing a certificate pursuant to California 
Corporations Code section 1505 mu st include the California street address where process may be 
served.  A post office box address for an agent  for service of process will not be accepted on any 
document. 
 
Future File Date Requests 
 
All future file date requests for corporation and limited liability company documents must be 
included within the document submitted or as an attachment to be made part of the filed 
document. 
 
Corporation and limited liability company documents received before January 1, 2013, with a 
future file date on or after January 1, 2013, must  comply with the entity and agent addresses 
requirements listed above. This information may be included in an attachment as part of the filed 
document.       
 
Copy Requests 
 
The Secretary of State will no longer endorse and certify customer-provided copies.  However, a 
customer who submits documents with a filing  fee of $25.00 or more will receive one (1) 
uncertified copy of the documents for free and,  at the time of filing, the free copy may be 
certified for a $5.00 certification fee.  Customer s requesting additional copies will be charged 
$1.00 for the first page and $0.50 for each additional page.  Each certified copy requires an 
additional $5.00 certification fee. 
 
Note:  While domestic stock and foreign corpora tions are required to pay a total of $25.00 when 
filing the required Statement of Information, the  total fees include a $20.00 filing fee and a $5.00 
disclosure fee.  Therefore, customers reque sting copies of a Statement of Information 
(corporation or limited liability company) mu st include the copy fees described above.

Instructions for Completing Form LLC-12	  	
Every domestic and registered foreign limited liability company  shall file a Statement of Information with the Secretary of State, within 90 
days after the filing of its original Articles of Organization  or Application for Registration, and biennially thereafter durin g the applicable filing 
period.  The applicable filing period for a limited liability company  is the calendar month during which its original Articles of Organization or 
Application for Registration were filed and the immediately preced ing five calendar months.  A limited liability company 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 fi ling a new form, completed in its entirety. 
Legal Authority:   Statutory filing provisions are found  in California Corporations Code section  17060, unless otherwise indicated.  All 
subsequent statutory references are to the California Corporations Code, unless otherwise  stated.  Failure to file this Statement of Information 
by the due date will result in the as sessment of a $250.00 penalty. (Sections  17651(b) and  17653; California Revenue and Taxation Code 
section  19141.) 
Filing Fees:  The fee for filing the initial or bi ennial Statement of Information is  $20.00.  Checks should be made paya ble to the Secretary of 
State.  If this statement  is being filed to change any information on a previously filed statement and is being filed outside t he applicable filing 
period, as defined above,  no fee is required.   
Copies:   The Secretary of State will endorse file on e copy of the statement if an exact copy is submitted along with the statement to b e filed.  
Copies submitted with the statement to be  filed can be certified upon request and payme nt of the $8.00 per copy certification fee. 
Complete the Statement of Info rmation (Form LLC-12) as follows: 
Item 1.  Enter the name of the limited liability company  exactly as it is of record with t he California Secretary of State. 
Item 2.  Enter the Limited Liability Company number i ssued by the California Secretary of State. 
Item 3.  Enter the state or place under the laws of which the limited liability company is organized. 
Item 4.  
  If no Statement of Information has ever
 been filed or if there has been any	
 change to the last Statement of Information filed with the 
ecretary of State, including  a change to any address, complete this form in its entirety. 
S
 
If there has been no change in the information contained in the last  Statement of Information filed with the Secretary of State , check 
the box and proceed to Item 15. 
Item 5.   Enter the complete street address, city, state and zip code of the  limited liability company’s principal executive office.  Please do not 
enter a P.O. Box or abbreviate the name of the city. 
Item 6.   Enter the complete mailing address, city, state and zip code of  the limited liability company if different from Item 5.  This address will 
be used for mailing purposes. 
Item 7.   If the limited liability company is formed under the laws of the  state of California, enter the complete street address, city  and zip 
code of the office required to be maintained pursuant to Section  17057(a).  Please do not enter a P.O. Box or abbreviate the name 
of the city. 
Item 8.   Enter the name and complete business or residential address of t he chief executive officer, if any.  Please do not abbreviate the 
name of the city. 
Items   Enter the name  and complete  business or residential  address of   any  manager or  managers, appointed or elected in accordance 
9-11.  with the Articles of Organization or Operating Agreement, or if no manager has been so elected or appointed, the name and 
business or residential address of each member.  Attach additiona l pages, if necessary.  Please do not abbreviate the name of the 
city.  
Item 12.   Enter the name of the agent for service of process in California.   An agent is an individual (manager, member or any other person, 
whether or not affiliated with the company) who resides in Califor nia or a corporation designated to accept service of process if the 
company is sued.  The agent  must agree to accept service of process on beh alf of the company prior to designation.  
 
  Note:  Before a corporation is designated as agent, that corporation must have previously file d with the California Secretary of 
State, a certificate  pursuant to Section  1505.   Note, a limited liability company 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 in the reco rds of the California Secretary of State.  
 
  If an individual is designated as agent, complete Items 12 and 13.  If a corporation is designated as agent, complete Item 12  and 
proceed to Item 14 (do not complete Item 13).    
Item 13.   If an individual is designated as agent for serv ice of process, enter a business or residential street address in California.  (A P.O. 
Box address is not acceptable).  Please do not enter “in care  of” (c/o) or abbreviate the name of the city.  If a corporation is 
designated as agent, leave Item 13 blank and proceed to Item 14. 
Item 14.   Briefly describe the general type of business that constitute s the principal business activity of the limited liability company. 
Item 15.  Type or print the name and title of the person completing this form and enter the date this form was completed. 
Completed forms along with the applicable f ees 
can be mailed to Secretary	
  of State, Statement of Information Unit, P.O. Box 944230, 
Sacramento, CA  94244-2300 or delivered in person (drop off) to  the Sacramento office, 1500 11th Street, Sacramento, CA  95814.  If 
you are not completing this form online, please type or legibly print in black or blue ink.  This form must not be altered.

L	State of California	 	
Secretary of State 	
STATEMENT OF INFORMATION  	
 	 	
 	(Limited Liability Company) 	
Filing Fee $20.00.  If this is an amendment, see instructions. 	
IMPORTANT — READ INSTRUCTIONS BEFORE COMPLETING THIS FORM 	 1.  LIMITED LIABILITY COMPANY NAME	 	
  	
This Space For Filing Use Only	 	
File Number and State or Place of Organization	 	 2.  SECRETARY OF STATE FILE NUMBER 	 3.  STATE OR PLACE OF ORGANIZATION (If formed outside of California) 
 	
No Change Statement	 	 
4. 	If there have been any changes to the in formation contained in the last Statement of  Information filed with the California Secretary of 
State, or no statement of information has been previously  filed, this form must be completed in its entirety.	 
 	
     If there has been no change in any of the information contained in  the last Statement of Information filed with the California Secretary of 
    State, check the box and proceed  to Item 15.  	   	
Complete Addresses for the Following   	(Do not abbreviate the name of the city.  Items 5 and 7 cannot be P.O. Boxes.)	 	
5.  STREET ADDRESS OF PRINCIPAL EXECUTIVE OFFICE 
 
 	 CITY STATE 	 ZIP CODE 	
6.  MAILING ADDRESS OF LLC,  IF DIFFERENT THAN ITEM 5	 	CITY  STATE	 	ZIP CODE	 	
 7. CALIFORNIA OFFICE WHERE RECORDS ARE MAINTAINED  (DOMESTIC ONLY) 	 CITY STATE    CA 	
 ZIP CODE 	
7.  EMAIL ADDRESS FOR RECEIVIN G STATUTORY NOTIFICATIONS 
Name and Complete Address of the Chief Executive Officer, If Any  8. NAME 	 ADDRESS 	 CITY  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.)	 	 9. NAME  	 ADDRESS 	 CITY   STATE 	 ZIP CODE 	
 10. NAME  	 ADDRESS 	 CITY  STATE 	 ZIP CODE 	
 11. NAME  	 ADDRESS 	 CITY  STATE  	 ZIP CODE 	
Agent for Service of Process  	If the agent is an individual, the agent must reside in California  and Item 13 must be completed with a California address,  a 
P.O. Box is not acceptable.  If the agent is a corporation, the agent must have on file with the California Secretary of State  a certificate pursuant to California 
Corporations Code section 1505 and Item 13 must be left blank.	
 	 12.  NAME OF AGENT FOR SERVICE OF PROCESS 
 13.  STREET ADDRESS OF AGENT FOR SER VICE OF PROCESS IN CALIFORNIA, IF AN INDIVIDUAL 	 CITY STATE	 	
 CA 	
 ZIP CODE 	
Type of Business	 	 14.  DESCRIBE THE TYPE OF BUSINESS  OF THE LIMITED LIABILITY COMPANY 
        
 
 
 15.  THE INFORMATION CONTAINED HEREIN, INCLUDI NG ANY ATTACHMENTS, IS TRUE AND CORRECT.	 	
   DATE   TYPE OR PRINT NAME OF PERSON  COMPLETING THE FORM  TITLE   SIGNATURE 
LLC-12 (REV 01/2012)   APPROVED BY SECRETARY OF STATE