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Question	Answer
Form Name	Si 200 C
Form Length	2 pages
Fillable?	Yes
Fillable fields	27
Avg. time to fill out	5 min 54 sec
Other names	form si 200 form, 200n c si, si 200, si 200 form state of california

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Instructions For Completing Form SI-200 C

Where to File: For faster processing, the required statement for most corporations can be filed online at https://businessfilings.sos.ca.gov/. Alternatively, statement forms are available on the Secretary of State’s website at www.sos.ca.gov/business/be/statements.htm and can be viewed, filled in and printed from your computer. Completed forms along with the applicable fees 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 is filed only in the Sacramento office.

Every domestic stock and agricultural cooperative corporation must file a Statement of Information with the California Secretary of State, within 90 days after filing of the initial Articles of Incorporation, and annually thereafter during the applicable filing period. The applicable filing period for a corporation is the calendar month during which the initial Articles of Incorporation were filed and the immediately preceding five calendar months. A corporation 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 filing a new form, completed in its entirety.

Legal Authority: Statutory filing provisions are found in California Corporations Code section 1502 or California Food and Agricultural Code section 54040, 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 assessment of a $250.00 penalty (Section 2204; California Revenue and Taxation Code section 19141).

Fees: The Statement of Information must be accompanied by a $20.00 filing fee and $5.00 disclosure fee. The filing fee and the disclosure

fee may be included in a single check made payable to the Secretary of State. All domestic stock and agricultural cooperative

corporations must pay a total of $25.00 at the time of filing the statement. If this statement is being filed to amend any information on a previously filed statement and is being filed outside the applicable filing period, as defined above, no fee is required.

Copies: The Secretary of State will endorse file one copy of the statement if an exact copy is submitted along with the statement to be filed.

Copies submitted with the statement to be filed can be certified upon request with payment of $8.00 per copy.

Publicly Traded Corporations: Every publicly traded corporation also must file a Corporate Disclosure Statement (Form SI-PT) annually, within 150 days after the end of its fiscal year. A “publicly traded corporation” is a corporation, as defined in Section 162, that is an issuer as

defined in Section 3 of the Securities Exchange Act of 1934, as amended (United States Code, title 15, section 78c), and has at least one class of securities listed or admitted for trading on a national securities exchange, on the OTC-Bulletin Board, or on the electronic service

operated by Pink OTC Markets Inc. Form SI-PT may be obtained from the Secretary of State’s website at www.sos.ca.gov/business/be/statements.htm or by calling the Statement of Information Unit at (916) 657-5448.

Complete the Statement of Information (Form SI-200 C) as follows:

Item 1. Item 2.

Item 3.

Enter the name of the corporation exactly as it is of record with the California Secretary of State.

Enter the complete street address, city, state and zip code of the principal executive office. Please do not enter a P.O. Box or abbreviate the name of the city.

Enter the complete street address, city and zip code of the corporation’s principal office in California, if any. Please do not enter a P.O. Box or abbreviate the name of the city. Complete this item only if the address in Item 2 is outside of California.

Item 4. Enter the mailing address of the corporation, if different from the street address of the principal executive office.

Items Enter the name and complete business or residential address of the corporation's chief executive officer (i.e., president), secretary

5-7. and chief financial officer (i.e., treasurer). Please do not abbreviate the name of the city. The corporation must have these three officers (Section 312(a)). Any number of offices may be held by the same person unless the articles or bylaws provide otherwise, except, in the case of an agricultural cooperative, neither the president nor the secretary may be the same person (California Food and Agricultural Code section 54149). Please note, unless the articles or bylaws provide otherwise, the president, or if there is no president, the chairman of the board, is the chief executive officer of the corporation. A comparable title for the specific officer may be added; however, the preprinted titles on this form must not be altered.

Items 8-10.

Item 11. Item 12.

Item 13.

Item 14. Item 15.

Enter the name and complete business or residential address of each incumbent director. If there are more than three directors, please attach additional pages. Please do not abbreviate the name of the city. The corporation must have at least one director (Section 212(a)).

Enter the number of vacancies on the board of directors, if any.

Enter the name of the agent for service of process in California. An agent is an individual (director, officer or any other person, whether or not affiliated with the corporation) who resides in California or another corporation designated to accept service of process if the corporation is sued. The agent must agree to accept service of process on behalf of the corporation prior to designation.

If an individual is designated as agent, complete Items 12 and 13. If another corporation is designated as agent, complete Item 12

and proceed to Item 14 (do not complete Item 13).

Note: Before another corporation may be designated as agent, that corporation must have previously filed with the California

Secretary of State, a certificate pursuant to Section 1505. A corporation 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 on the records of the California Secretary of State.

If an individual is designated as agent for service 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 another corporation is designated as agent, leave Item 13 blank and proceed to Item 14.

Briefly describe the general type of business that constitutes the principal business activity of the corporation.

Type or print the name and title of the person completing this form and enter the date this form was completed. By submitting this Statement of Information to the California Secretary of State, the corporation certifies the information contained herein, including

any attachments, is true and correct.

State of California	s
	—

Secretary of State

Statement of Information

(Domestic Stock and Agricultural Cooperative Corporations)

FEES (Filing and Disclosure): $25.00. If amendment, see instructions.

IMPORTANT - READ INSTRUCTIONS BEFORE COMPLETING THIS FORM

1. CORPORATE NAME

This Space for Filing Use Only

Due Date:

Complete Addresses for the Following (Do not abbreviate the name of the city. Items 2 and 3 cannot be P.O. Boxes.)

2.	STREET ADDRESS OF PRINCIPAL EXECUTIVE OFFICE	CITY	STATE	ZIP CODE
3.	STREET ADDRESS OF PRINCIPAL BUSINESS IN CALIFORNIA, IF ANY	CITY	STATE	ZIP CODE
			CA
4.	MAILING ADDRESS OF THE CORPORATION, IF DIFFERENT THAN ITEM 2	CITY	STATE	ZIP CODE

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

Names and Complete Addresses of All Directors, Including Directors Who are Also Officers (The corporation must have at least one

director. Attach additional pages, if necessary.)

8.	NAME	ADDRESS	CITY	STATE	ZIP CODE
9.	NAME	ADDRESS	CITY	STATE	ZIP CODE
10.	NAME	ADDRESS	CITY	STATE	ZIP CODE

11. NUMBER OF VACANCIES ON THE BOARD OF DIRECTORS, IF ANY:

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 street address (a P.O. Box 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 13 must be left blank.)

13. STREET ADDRESS OF AGENT FOR SERVICE OF PROCESS IN CALIFORNIA, IF AN INDIVIDUAL	CITY	STATE ZIP CODE
		CA

Type of Business

14.DESCRIBE THE TYPE OF BUSINESS OF THE CORPORATION

15.BY SUBMITTING THIS STATEMENT OF INFORMATION TO THE CALIFORNIA SECRETARY OF STATE. THE CORPORATION CERTIFIES THE INFORMATION CONTAINED HEREIN, INCLUDING ANY ATTACHMENTS, IS TRUE AND CORRECT.

DATE	TYPE/PRINT NAME OF PERSON COMPLETING FORM	TITLE	SIGNATURE
SI-200C (REV 10/2010)			APPROVED BY SECRETARY OF STATE

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