California Non Profit Corporation Statement of Information Form

California Statement of Information Form.pdf Use this form within 90 days after filing your Non-Profit Articles of Organization and attach a check for $20 made to the California Secretary of State an

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State of California
Secretary of State
Statement of Information
(Domestic Nonprofit, Credit Union and Consumer Cooperative Corporations)
Filing Fee: $20.00. If this is an amendment, see instructions.
IMPORTANT – READ INSTRUCTIONS BEFORE COMPLETING THIS FORM
1. CORPORATE NAME
2. CALIFORNIA CORPORATE NUMBER
This Space for Filing Use Only
Complete Principal Office Address (Do not abbreviate the name of the city. Item 3 cannot be a P.O. Box.)
3. STREET ADDRESS OF PRINCIPAL OFFICE IN CALIFORNIA, IF ANY CITY STATE
CA
ZIP CODE
4. MAILING ADDRESS OF THE CORPORATION CITY STATE ZIP CODE
5. EMAIL ADDRESS FOR RECEIVING STATUTORY NOTIFICATIONS
Names and Complete Addresses of the Following Officers (The corporation must list these three officers. A comparable title for the specific
officer may be added; however, the preprinted titles on this form must not be altered.)
5. CHIEF EXECUTIVE OFFICER/ ADDRESS CITY STATE ZIP CODE
6. SECRETARY ADDRESS CITY STATE ZIP CODE
7. CHIEF FINANCIAL OFFICER/ ADDRESS CITY STATE ZIP CODE
Agent for Service of Process If the agent is an individual, the agent must reside in California and Item 9 must be completed with a California street
address, a P.O. Box address is not acceptable. If the agent is another corporation, the agent must have on file with the California Secretary of State a
certificate pursuant to California Corporations Code section 1505 and Item 9 must be left blank.
8. NAME OF AGENT FOR SERVICE OF PROCESS
9. STREET ADDRESS OF AGENT FOR SERVICE OF PROCESS IN CALIFORNIA, IF AN INDIVIDUAL CITY STATE
CA
ZIP CODE
Davis-Stirling Common Interest Development Act (California Civil Code section 1350, et seq.)
10. Check here if the corporation is an association formed to manage a common interest development under the Davis-Stirling Common Interest
Development Act.
NOTE: Corporations formed to manage a common interest development must also file a Statement by Common Interest Development Association
(Form SI-CID) as required by California Civil Code section 1363.6. Please see instructions on the reverse side of this form.
11. THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT.
DATE TYPE/PRINT NAME OF PERSON COMPLETING FORM TITLE SIGNATURE
SI-100 (REV 01/2012) APPROVED BY SECRETARY OF STATE