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
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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
Submission Cover Sheet
Instructions:
Complete and include this form with your submission. This information only will be used to communicate with you
in writing about the submission. 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: $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. For updated processing time information, visit
www.sos.ca.gov/business/be/processing-dates.
Optional
Copy and Certi
fication Fees:
If applicable, include optional copy and certification fees with your submission.
For applicable copy and 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): _____________________________________
Comments: _____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
Return Address: For written communication from the Secretary of State related to this document, or if
purchasing a copy of the filed document enter the name of a person or company and the mailing address.
Secretary of State Use Only
T/TR:
AMT REC’D: $
Name:
Company:
Address:
City/State/Zip:
Doc Submission Cover - BE (Rev. 11/2020)
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