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

                                                   Submission Cover Sheet

For faster service, file online at bizfileOnline.sos.ca.gov               . 

Instructions: 

• Complete and include this form with your paper submission. This information only will be
  used to communicate in writing about the submission, if needed. This form will be
  treated as correspondence and 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 handling fee; do not include
  a $15 handling fee when submitting documents by mail.

• Standard processing time for submissions to this office is approximately 5 business days from
  receipt. 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.

Optional Copy and Certification Fees: 

• If applicable, include optional certification fees with your submission.

• For applicable certification fee information, refer to the instructions of the specific form you are
  submitting.

Contact Person: (Please type or print legibly) 

First Name:                                      Last Name: 

Phone (optional):  

Entity Information: (Please type or print legibly) 

Name:  

Entity Number (if applicable):  

Address: 

Comments

Submission Cover Sheet (REV 03/2022)                            Clear Form  Print Form

                  Secretary of State                 LLC-12NC 
                  Statement of Information – 
                  No Change 
                  (Limited Liability Company) 

This form may be used only if a complete Statement of Information has 
been filed previously and there has been no change.  

Filing Fee  –  $20.00 

Certification Fee (Optional) –  $5.00 
                                                                                Above Space For Office Use Only 

1. Limited Liability Company Name (Enter the exact name on file with the California Secretary of State.  Note:  If you
   registered in California using an alternate name.)

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

4. No  Change  Statement        (Do not alter the No Change Statement.  If there has been any change, file the Statement of
   Information online at bizfileOnline.sos.ca.gov.)

      There has been no change in any of the information contained in the 
      previous complete Statement of Information filed with the California 
      Secretary of State. 

5. 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 of Person Completing the Form Title   Signature 

LLC-12NC (REV 03/2022)                  Clear Form      Print Form                            20 22California Secretary of State 
                                                                                                   bizfileOnline.sos.ca.gov