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Statement by Foreign Corporation (California)

This is a statement by a foreign corporation in California. The form provided here is simply a sample of what the actual form looks like.

State of California
Bill Jones
Secretary of State

STATEMENT BY FOREIGN CORPORATION

1. CORPORATE NUMBER: ______________________________

CORPORATE NAME: ______________________________

____ IF THERE HAS BEEN NO CHANGE IN ANY OF THE INFORMATION CONTAINED IN THE LAST STATEMENT BY FOREIGN CORPORATION ON FILE WITH THE CALIFORNIA SECRETARY OF STATE, CHECK THE BOX AND PROCEED TO ITEM 11.

2. STREET ADDRESS OF PRINCIPAL EXECUTIVE OFFICE

______________________________

CITY ____________________________

STATE ____________________________

ZIP CODE ____________________________

3. STREET ADDRESS OF PRINCIPAL BUSINESS OFFICE IN CALIFORNIA, IF ANY

______________________________

CITY ____________________________

STATE CA

ZIP CODE ____________________________

4. MAILING ADDRESS ______________________________

CITY ____________________________

STATE ____________________________

ZIP CODE ____________________________

LIST THE NAMES AND COMPLETE ADDRESSES OF THE OFFICERS: (The corporation must have these three officers. An officer may hold more than one office. The appropriate title for the officer may be added but do not alter or obliterate the form).

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 ____________________________

18. CHECK THE APPROPRIATE PROVISION BELOW AND NAME THE AGENT FOR SERVICE OF PROCESS:

[____] AN INDIVIDUAL RESIDING IN CALIFORNIA.

[____] A CORPORATION WHICH HAS FILED A CERTIFICATE PURSUANT TO SECTION 1505 OF THE CALIFORNIA CORPORATIONS CODE.

AGENT'S NAME: ______________________________

9. ADDRESS OF THE AGENT FOR SERVICE OF PROCESS IN CALIFORNIA, IF AN INDIVIDUAL

______________________________

CITY ____________________________

STATE CA

ZIP CODE ____________________________

10. DESCRIBE THE TYPE OF BUSINESS OF THE CORPORATION

____________________________

11. I DECLARE THAT I HAVE EXAMINED THIS STATEMENT AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, IT IS TRUE, CORRECT AND COMPLETE.

TYPE OR PRINT NAME OF SIGNING OFFICER OR AGENT

______________________________

ORIGINAL SIGNATURE ______________________________

TITLE ______________________________

DATE ______________________________


NOTES

Statutory filing provisions are found in Section 1502 of the California Corporations Code, unless otherwise indicated.

Every foreign corporation shall file a statement with the California Secretary of State, (beginning January 1, 2000), biennially during the applicable filing period. The applicable filing period for the foreign corporation shall be the end of the calendar month of the anniversary date of qualification and the immediately preceding five calendar months. Foreign corporations that have, or will be organized by filing Statement and Designation by Foreign Corporation during the months of January, March, May, July, September and November will be due to file in odd years and those organized in the months of February, April, June, August, October and December will be due to file in even years.

If this is a biennial statement attach the fee of $20. If this filing is a change to any information on an initial statement or a biennial statement there is no fee.

A foreign corporation is required to file a statement as long as the corporation is in good standing in the corporate records in California even though it may not be actively engaged in business at the time this statement is due. If the corporation has dissolved or merged in its domestic state it should file a certificate of surrender to clear the corporate records in California.

Failure to file this completed form by the preprinted due date in Item 1 or within 90 days of incorporation will result in the assessment of a $250 penalty. (Section 2204, California Corporations Code, and Section 19141, Revenue and Taxation Code).

For further information, contact the Statement of Officers Unit at (916) 657-3537.


-----------------------------
INSTRUCTIONS FOR FILLING OUT THIS FORM
-----------------------------

Type or legibly print in black or blue ink.

· Make check payable to the Secretary of State.

· Send the executed document and filing fee to:

California Secretary of State
Statement of Officers
P.O. Box 944230
Sacramento, CA 94244-2300

· Please make a copy of the completed form and submit with the original if you wish an endorsed filed copy for your files.

Fill in the items as follows:

Item 1. Do not alter the preprinted corporate name. If the corporation name has been changed and is not correct, please attach a statement indicating the correct name and the date the amended statement and designation showing the name change was filed with the Secretary of State. If the space is blank, enter the exact corporate name and number.

IF THERE HAS BEEN NO CHANGE IN THE INFORMATION CONTAINED IN THE LAST STATEMENT ON FILE WITH THE CALIFORNIA SECRETARY OF STATE, CHECK THE BOX AND PROCEED TO ITEM 11.

IF THERE HAVE BEEN "ANY" CHANGES TO THE LAST BIENNIAL STATEMENT ON FILE WITH THE CALIFORNIA SECRETARY OF STATE, COMPLETE THIS STATEMENT IN ITS ENTIRETY (ITEMS 2-11)

Item 2. Enter the complete street address, city, state and zip code, of the principal executive office. DO NOT enter a P.O. Box or abbreviate the name of the city.

Item 3. Enter the complete street address, city and zip code of the corporation's principal office in California, if any. Complete this item only if the address in Item 2 is outside of California. DO NOT abbreviate the name of the city.

Item 4. Enter the mailing address of the corporation.

Item 5-7. Enter the name and complete business or residential address of the corporation's chief executive officer (i.e. president), secretary and chief financial officer (i.e. treasurer). DO NOT abbreviate the name of the city. The corporation must have these three officers (Section 312, California Corporations Code). An officer may hold more than one office. You may add a title appropriate for your corporation but do not alter or obliterate preprinted titles.

Item 8. Enter the name of the agent for service of process in California. The person named as agent must be a resident of California or a corporation which has filed a certificate pursuant to Section 1505 of the California Corporations Code. If an individual is designated as agent, proceed to Item 9. If a corporation is designated, proceed to Item 10 (do not complete Item 9).

Item 9. If an individual is designated as the agent for service of process, enter a business or residential address in California. DO NOT enter "in care of" (c/o) or abbreviate the name of the city. DO NOT enter an address if a corporation is designated as the agent for service of process.

Item 10. Briefly describe the general type of business that constitutes the principal business activity of the corporation. Explanation must be descriptive and brief. (Example: Manufacture of aircraft, Auto parts distributor, Retail department store).

Item 11. Type or print name of the signing officer or agent. Original signature and title of corporate officer or agent is required to complete the form. Enter date the form is signed.

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