Secretary of State
Business Programs Division
Statement of Information
1500 11th Street, Sacramento, CA 95814
P.O. Box 944230,
Sacramento, CA 94244-2300
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.
• 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, go to
www.sos.ca.gov/business/be/processing-dates.
Optional Copy and Certification 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.
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.
A
Secretary of State Use Only
T/TR:
MT REC’D: $
Name:
Company:
Address:
City/State/Zip:
Doc Submission Cover - SI (Rev. 11/2020)
