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Secretary of State
Business Programs Division
Business Entities
1500 11th Street, Sacramento, CA 95814
P.O. Box 944260, Sacramento, CA 94244-2600

Business Entities Submission Cover Sheet

For faste stservice, file online at bizfileOnline.sos.ca.gov.

Instructions:

• Complete and include this form with your paper submission. This form will not be made part of
the filed document.

• Make all checks or money orders payable to the Secretary of State.

• In-person submissions (excluding Statements of Information): $15 special handling fee . Do not
include a $15 special handling fee when submitting documents by mail.

• All submissions are reviewed in the date order of receipt , with online submissions given priority.
For updated processing time information, visit www.sos.ca.gov/business/be/processing-dates.

• To obtain a certified copy, includ ecertification fees with your submission.

Note: All correspondence related to your submission will be
sent to the name and address on your check or money order.

Contact Person (Please type or print legibly):

First Name: Last Name:

Phone Number: Email:

Entity Information (Please type or print legibly):

Entity Name:

Entity Number (if applicable):

Comments:

Clear Form Print Form
Submission Cover Sheet (REV 03/2024)

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                                         Instructions for Completing  the  
                                 Statement    of Information             (Form LLC-12) 
Every California and registered foreign            limited liability company must file a Statement   of Information 
with the California    Secretary of State, within 90 days   ofregistering with the California Secretary of                 State,   
and every two years thereafter during a specific 6-month            filing period based on    the original  registration 
date, as described in the chart     below. 

All Statements of Information         for limited  liability  companies can     be filed    onlineusing     our bizfile 
Online portal at bizfile nline.sos.ca.govO        .
                                                                                                                                    
Status of LLC:    In order to file Form LLC-12,         the status  of the   LLCmust  be active or suspended/forfeited 
on the records   of the  California   Secretary    of State. The status of the LLC   can    be checked    online on the             
Secretary of S tate’s Business Search     at  bizfile nline.sos.ca.gov/search/businessO        . See the    FTB 
Suspension/Forfeiture section below for information about resolving an FTB suspended/forfeited status. 
                                                                                                     
Fees: See chart below. Checks should be made payable to the Secretary of State. 
                                                                                                                                     
Copies:   Upon filing, we will   return  one  (1) plain copy of   your filed document   for free  and will certify        the      
copy upon    request   and payment   of a $5 certification fee.                                                             
                                                                                                                                   
Processing Dates:       For current processing dates, go to www.sos.ca.gov/business/be/processing-dates. 

Type of 
                                 Description                                    Online/Form                                Fee 
Filing 
Initial Filing     The initial filing is due 90 days from           File online at bizfile nline.sos.ca.govO         .  $20.00 
                   the entity’s registration date.                  (Form LLC-12)  

Required           •   The periodic filing is due every two         File online at bizfile nline.sos.ca.govO         .    $20.00 
Periodic               years based on the entity’s                    (Form LLC-12, if changes have been 
Filing                 registration date.                           made)         
                   •   If the registration occurred in an               
                       even-numbered year, the periodic                                                     
                       filing is due every even year.                                                        
                   •   If the registration occurred in an                            
                       odd-numbered year, the periodic
                       filing is due every odd year.
                   •   The filing period includes the
                       registration month    and the
                       immediately preceding five (5)
                       months.
No Fee             A Statement of Information is                    File online at  bizfile nline.sos.ca.gov.O            No Fee 
Statement          submitted after the initial or required          (Form LLC-12) 
                   filing requirements have been met  to 
                   update information including changes  
                   to the agent for service of process. 

LLC-12 (REV  12/2022)                                                                               202 2 California Secretary of State 
                                                                                                           bizfile       Online.sos.ca.gov

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               Statutory Required 6 Month Filing Window for Limited Liability Companies 

              Month of Formation,                     Statement of Information 
              Registration or Conversion              Applicable Filing Period 
                                                  First Day of          Through Last Day 
              January                               August                    January 
              February                            September                   February 
              March                                 October                   March 
              April                                 November                    April 
              May                                   December                    May 
              June                                  January                     June 
              July                                  February                    July 
              August                                March                     August 
              September                               April                   September 
              October                                 May                     October 
              November                                June                    November 
              December                                July                    December 

If you are not completing this form online, type or print legibly in black or blue ink.  Complete the 
Statement of Information (Form LLC-12)        as follows: 

Item  Instruction                                   Tips 
   1.  Enter the name of the limited liability      • To ensure you have the exact name of the LLC, refer
       company exactly as it appears on file          to your registration document filed with the California
       with the California Secretary  of State,       Secretary of State and any name change
       including the entity ending                    amendments.
       (ex: “Jones & Company, LLC” or “Smith        • Some foreign LLCs may have registered in California
       Construction, a Limited Liability              using an alternate  name.   If your LLC is a registered
       Company”).                                     foreign LLC using an alternate name in California,
                                                      you must enter  the complete alternate name.

   2.  Enter the Entity Number    issued to the     • The Entity (File) Number  is provided by the               
       LLC by the     California Secretary of         Secretary of State above the file stamp at the top of 
       State at the time of registration.             the LLC’s registration document filed with the 
                                                      California Secretary of State  or if filed electronically, 
                                                      in the top section, below  the Entity Name.
                                                    • Secretary of State Records can be accessed online 
                                                      through our Business Search at
                                                      bizfile nline.sos.ca.gov/search/businessO   . While         
                                                      searching the Business Search, be sure to identify 
                                                      your LLC correctly including the jurisdiction       that 
                                                      matches your LLC.

   3.  If formed outside of California, enter       • The jurisdiction must match the Secretary of State’s 
       the state, foreign country or other place      records.
       where the LLC   is organized.                • Secretary of State Records can be accessed online 
                                                      through our Business Search at
                                                      bizfile nline.sos.ca.gov/search/businessO   . While         
                                                      searching the Business Search, be sure to identify 
                                                      your LLC correctly including the jurisdiction       that 
                                                      matches your registered foreign LLC.

LLC-12 (REV  12/2022)                                                                 202 2 California Secretary of State 
                                                                                            bizfile       Online.sos.ca.gov

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Item Instruction Tips
• If the LLC is formed in California, leave Item 3 blank.

4a. Enter the complete street address, city, • The complete street address is required, including
state and zip code of the LLC’s the street name and number, city, state and zip code.
must be a physical address.
principal office. • Address
• Do not enter a P.O. Box address, an “in care of”
address, or abbreviate the name of the city.

4b. If different from the address in Item 4a, • This address will be used for mailing purposes and
enter the complete mailing address, may be a P.O. Box address or “in care of” an
city, state and zip code of the LLC. individual or entity.
• Do not abbreviate the name of the city.

4c. • If the LLC is formed in California, • The complete street address is required, including
enter the complete street address, the street name and number, city and zip code.
city and zip code of the office in • Address must be a physical address in California.
California, if different from Item 4a.
• Do not enter a P.O. Box address, an “in care of”
• If the LLC is formed outside of address, or abbreviate the name of the city.
California, enter the complete street
address, city and zip code of the • If Item 4a is an address in California leave Item 4c
principle business office in California, blank and proceed to Item 5.
if any.

5. Enter the name and complete business • If the LLC has more than one manager or member,
or residential address of any enter the name(s) and address(es) of the additional
manager(s), appointed or elected in mangers or members on Form LLC-12A.
accordance with the Articles of • Please do not abbreviate the name of the city.
Organization or Operating Agreement,
or if no manager(s) has been so • Review your Articles of Organization or any
elected or appointed, the name and amendments thereto, to determine if the LLC is run
business or residential address of each by a single manager, more than one manager or by
member. its member(s).
• Every LLC is required to have at least one
manager/member.
• A member(s) is the owner of the LLC similar to a
shareholder(s) in a corporation.

6. The LLC must have an Agent for • An Agent for Service of Process is responsible for
Service of Process. accepting legal documents (e.g. service of process,
There are two types of Agents that can lawsuits, subpoenas, other types of legal notices,
be named: etc.) on behalf of the LLC.
• an individual (e.g., member, manager, • You must provide information for either an individual
or any other individual) who resides in OR a registered corporate agent, not both.
California with a physical California • If using a registered corporate agent, the corporation
street address; OR must have a current agent registration certificate on
• a registered corporate agent qualified file with the California Secretary of State as required
with the California Secretary of State. by Section 1505.

6a & b. If Individual Agent: • The complete street address is required, including
• Enter the name of the agent for the street name and number, city and zip code.
service of process and the agent’s • Do not enter a P.O. Box address, an “in care of”
complete California street address, address, or abbreviate the name of the city.
city and zip code.
• Many times, a small LLC will designate a member or
LLC-12 (REV 12/2022) 202 2 California Secretary of State
bizfile Online.sos.ca.gov

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Item  Instruction                                 Tips 
       • If an individual is designated as the      manager as  the agent for service of process.  
           agent, complete Items 6a and 6b        • The individual agent should be aware that  the name
           ONLY.  Do not complete Item 6c.          and the physical street address of  the agent for
                                                    service of process is a  public record, open to all (as
                                                    are  all the addresses of the LLC provided in filings).

6c.    If Registered Corporate Agent:             • Before a corporation is designated as agent for the
                                                  LLC, that corporation must have a current agent
       • Enter  the name of the registered
                                                  registration certificate on file with the California
           corporate agent exactly  as registered                                       
                                                  Secretary of State as required by Section 1505 stating
           in California.                                                                                        
                                                  the address(es) of the registered corporate agent and
       •
           If a registered corporate agent is     the authorized employees that will accept service of
           designated as the agent, complete      process of legal documents and notices on behalf of
           Item  6c ONLY.  Do not complete        the LLC.
           Items 6a and 6b.
                                                  • Advanced approval  must be obtained   from a
                                                  registered corporate agent  prior   to designating that
                                                  corporation as your agent for service of process.
                                                  • No California or foreign corporation may register as
                                                  California corporate agent unless the corporation
                                                  currently is authorized to engage in business in
                                                  California and is in good standing on the records of            the
                                                  California Secretary of State. 
                                                  • Provide your Registered Corporate Agent’s exact
                                                  name as registered with the California Secretary of
                                                  State. To confirm that you are providing the exact
                                                  name of the Registered Corporate Agent, go to                  
                                                  bizfile nline.sos.ca.gov/search/businessO  .

7.     Briefly describe the general type of 
       business that is the principal business  
       activity of the LLC. 

8.     Enter  the name and complete business      • A chief executive officer  may be in addition to
       or residential address of the chief          members and managers but generally is the person
       executive officer, if any.                   that occupies  the highest level position in the LLC’s
                                                    organization hierarchy in charge of managing the
                                                    LLC.

9.     Check either YES or NO to disclose   if      Manager-managed     California or manager-managed 
       any Manager or any Member have an            Out- -of State LLC: does any manager    have an 
       outstanding final judgment issued by         outstanding final judgment issued by the Division o          f
       the Division of Labor Standards              Labor Standards Enforcement or a court of law, for 
       Enforcement or a court of law, for           which no appeal therefrom  is pending, for the violation 
       which no appeal is pending, for the          of any wage order or provision of the Labor Code?
       violation of any wage order or provision 
                                                                     
       of the Labor Code.                           Member-managed California LLC: does any 
                                                                       
                                                    managing member have an outstanding final judgment 
                                                                              
                                                    issued by the Division of Labor Standards 
                                                    Enforcement or court of law, for which no appeal 
                                                                               
                                                    therefrom is pending, for the violation of any wage 
                                                                         
                                                    order or provision of the Labor Code?
    
                                                    NOTE: Pursuant to California Corporations Code 
                                                    section  17701.10(d), if a written operating agreement

LLC-12 (REV  12/2022)                                                              202 2 California Secretary of State 
                                                                                            bizfile       Online.sos.ca.gov

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                                                       limits the members who are agents of the limited 
                                                       liability company for     the purpose of its business 
                                                       and affairs to a specified member or specified                    
                                                       members, answer this question with respect to the 
                                                       specified member or members only.
                                                                                                                        
                                                       Out- -of State LLC that is not managed by a 
                                                                          
                                                       manager or managers: does any member have 
                                           
                                                       an outstanding final judgment issued by the 
                                                       Division of Labor Standards Enforcement      or court 
                                                       of law, for which no appeal is pending, for the   
                                                       violation of any wage order or provision of the 
                                                       Labor Code?                                                    
                                                         
                                                        NOTE: Answer this question     as to   the specified 
                                                       member or   members       that are agents of theout-of-           
                                                       state  limited liability company for purposes of its 
                                                       business and affairs only.

                                                       If the answer to any of the questions above is Yes, 
                                                       select the Yes option. Otherwise, select No. 

10.    Type or print the date, the name and 
       title of the person completing this form 
       and sign where indicated. 

Submission Cover Sheet (Optional): Complete and include with your paper submission. This information 
will be used to communicate with you about the submission, if needed. This submission cover sheet will be 
treated as correspondence and will not be made part of the filed document. 
Where to File:     For faster service, this form can befiled onlineatbizfile nline.sos.ca.govO  . The completed 
form along with the applicable fees can be mailed to Secretary of State, Statement of Information Unit, 
P.O. Box 944260, Sacramento, CA  94244-2600 or delivered in person (drop off) to the Sacramento office, 
1500 11th Street, Sacramento, CA  95814. 
Legal Authority:        General statutory filing provisions are found in Section 17702.09 unless otherwise 
indicated. All 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 assessment of a $250.00 
penalty. (Sections 17713.07(b) and 17713.09; California Revenue and Taxation Code section 19141.) 
FTB Suspension/Forfeiture:       If the LLC’s status is FTB suspended/forfeited, the status must be resolved 
with the California Franchise Tax Board (FTB) for the LLC to be returned to active status. For revivor 
requirements, go to the FTB’s website at https://www.ftb.ca.gov or contact the FTB at (800) 852-5711 
(from within the U.S.) or (916) 845-6500 (from outside the U.S.). 

LLC-12 (REV  12/2022)                                                                    202 2 California Secretary of State 
                                                                                                 bizfile       Online.sos.ca.gov

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Secretary of State LLC-12
Statement of Information
(Limited Liability Company)

This form is due within 90 days of initial
registration and every two years thereafter.

Filing Fee - $20.00

Certification Fee (Optional) -$5.00

This Space For Office Use Only

1. Limited Liability Company Name (Enter the exact name of the LLC. If you registered in California using an
alternate name.)

2. Secretary of State Entity Number 3. State, Foreign Country or Place of Organization
(only if formed outside of California)

4. Business Addresses
a. Street Address of Principal Office - Do not list a P.O. Box City (no abbreviations) State Zip Code

b. Mailing Address of LLC, if different than item 4a City (no abbreviations) State Zip Code

c. Street Address of California Office, if Item 4a is not in California City (no abbreviations) State Zip Code
Do not list a P.O. Box
CA

5. Manager(s) or Member(s) If no managers have been appointed or elected, provide the name and address of
each member. At least one name and address must be listed. If the
manager/member is an individual, complete Items 5a and 5c (leave Item 5b blank).
If the manager/member is an additional managers/members, enter the names(s)
and address(es) on Form LLC-12A .
a. First Name, if an individual - Do not complete Item 5b Middle Name Last Name Suffix

b. Entity Name - Do not complete Item 5a

c. Address City (no abbreviations) State Zip Code

LLC-12 (REV 12/2022) Page 1 of 2 2022 California Secretary of State
bizfileOnline.sos.ca.gov

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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 City (no abbreviations) State Zip Code
P.O. Box
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 Limited Liability Company

8. Chief Executive Officer, if elected or appointed
a. First Name Middle Name Last Name Suffix

b. Address City (no abbreviations) State Zip Code

9. Labor Judgment (See instructions)

Does a Manager or Member, as further defined by California orporationsC Code

section17702.09(a)(8), have an outstanding final judgment issued by the Division
of Labor Standards Enforcement or a court of law, for which no appeal is pending, Yes No

for the violation of any wage order of provision of the Labor Code?

10.0. Email Notifications

Provide an email address to opt-in to receive entity related notifications, including Statement of Information
reminders, by email rather than USPS mail. Note: If no email address is provided, you will continue to receive
notices and reminders by USPS mail.

Yes, I opt-in to receive entity notifications via email. Email Address: _____________________________________________

To change your option after filing, you must submit a new complete Statement of Information.

By signing, I affirm under penalty of perjury that the information herein is true and correct and that I am
authorized by California law to sign.

_____________________ ____________________________________________________________ ________________________ __________________________________
Date Type or Print Name Title Signature
LLC-12 (REV 12/2022) 202 2California Secretary of State
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