REG. NO.
REGISTRATION OF UNINCORPORATED NONPROFIT ASSOCIATION
PURSUANT TO CALIFORNIA CORPORATIONS CODE
SECTION 21300
Instructions:
1. Comple
te and mail to: Secretary of State, Document Filing Support Unit,
P. O. Box 944225, Sacramento, CA 94244-2250 (916) 657-5448
2. Include filing fee of $10.00
per box checked below.
This space For Filing Use Only
Association includes any lodge, order, beneficial association, fraternal or beneficial society, historical, military, or veterans
organization, labor union, foundation, or federation, or any other society, organization, or association, or degree, branch,
subordinate lodge, or auxiliary thereof.
Registration For:
Name Insignia Alteration Cancellation
Association Name
Street or Mailing Address City and State Zip Code
Nature of Alteration (If Any):
Description of Insignia, which may include badge, motto, button, decoration, charm, emblem, or rosette:
Attach Facsimile:
I declare under penalty of perjury under the laws of the State of California that I am a chief officer of the association; that I
am authorized to act on behalf of the association with respect to completing and submitting this application; that the
information contained in this application is true and correct.
Signature of Officer Date Signature of Additional Officer (Optional) Date
Typed Name and Title Typed Name and Title
Sec/State Form LP/UNA 128 (Rev. 11/2020)
State of California
Secretary of State
2020 California Secretary of State