Secretary of State Business Programs Division Special Filings, P.O. Box 942870, Sacramento, CA 94277-2870 Special Filings Records Order Form To obtain information relating to a special filing of record with the California Secretary of State, complete both pages of this order form, attach a check made payable to the Secretary of State for the appropriate amount or an amount "not to exceed" a specified amount written below the amount payable line, and submit your request: By mail, along with a self-addressed envelope, to Secretary of State, Special Filings, P.O. Box 942870, Sacramento, CA 94277-2870. In person (drop off), to the Secretary of State's Sacramento office at 1500 11th Street, 2nd Floor, Sacramento, CA 95814. A special handling fee of $6.00 per entity is applicable for any information requested over the counter. Note: Information requests are processed only in the Secretary of State's Sacramento office. Requestor's Information Your name: Firm name, if any: Address: City / State / Zip: Phone #: FAX #: Entity or Individual's Name (Also include the file number, if known.) Surety Bonds (Select the applicable type.) Auctioneer/Auction Company Dance Studio Employment Agency Foreclosure Consultant Health Studio Invention Developer Nurses' Registry Seller of Travel Business Discount Programs Credit Service Organization Discount Buying Organization Employment Counseling Service Guaranteed Traffic Arrest Bail Bond Immigration Consultant Job Listing Service Seller of Travel Discount Programs Misc. Filings (Select the applicable type.) Athlete Agent Disclosure Statement Athlete Agent Amendment to Disclosure Statement Domestic Partnerships: Declaration of Domestic Partnership Notice of Termination of Domestic Partnership Revocation of Termination of Domestic Partnership Builder's Agent for Notice Notice of a Joint Powers Agreement Amendment of a Joint Powers Agreement Registration of Claim as Successor-In-Interest Statement of Facts Roster of Public Agencies NPSF Records Order Form (Rev. 04/2015) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com California Secretary of State www.sos.ca.gov (916) 653-3984 Copy Requests Plain (uncertified) Copies: $1.00 for the first page and $0.50 for each additional page. Certified Copies: $1.00 for the first page, $0.50 for each additional page and $5.00 certification fee per document. If the number of pages is unknown when ordering copies, you may send either a check in the amount of $20.00 per entity (refunds will be issued for amounts over $5.00) or a blank check with a not to exceed amount written below the payment line (e.g., "Not to Exceed $20.00"). A notice will be included with the order indicating the amount for which the check was completed. If the fees provided are insufficient, a fee letter indicating the total amount due will be sent to the requestor. The order will be completed upon receipt of the total fees. Surety Bonds Only: Copy of all Documents of Record (e.g., initial bond, riders, cancellations, etc.) .............................. Plain Copies Certified Copies Certified Copies Certified Copies Certified Copies Copy of Initial Bond ........................................................................................................................ Copy of all Amendment Documents Copy of Enter the title of the document and, if known, the file date and/or document number. Plain Copies Plain Copies Plain Copies ......................................................................................... Domestic Partnerships Only: Copy of all Domestic Partnership Documents of Record ............................................................. Plain Copies Plain Copies Plain Copies Plain Copies Certified Copies Certified Copies Certified Copies Certified Copies Copy of Declaration of Domestic Partnership .......................................................................... Copy of Notice of Termination of Domestic Partnership ........................................................... Copy of Revocation of Termination of Domestic Partnership ................................................... Misc. Filings Only: Copy of all Documents of Record Copy of Enter the title of the document and, if known, the file date and/or document number. .................................................................................................... Plain Copies Plain Copies Certified Copies Certified Copies Certificates ­ $5.00 Each (excluding Domestic Partnerships) Certificate of Filing ................................................................................................................................................. Certificate of No Record ........................................................................................................................................... Certificate(s) Certificate(s) Special Handling Service ­ In Person Delivery Only Special Handling Fee (not applicable for orders submitted by mail) .................................................................................................. $6.00 per entity Online Searches Online access to certain special filings information is available as described below: Successor-In-Interest Search: Allows you to view The space below is reserved for office use only. Affix Cert. & Seal Making first page Making additional pages Certificate of Other Special Handling $ $ $ $ $ $ successor-in-interest claims filed with this office, containing the celebrity name, date of death, the name and address of the claimant and the interest claimed. Immigration Consultant Surety Bond Search: Allows you to view immigration consultant surety bond information filed with this office, containing the immigration consultant name, business name and address, bond status and term, photo, and bonding company name and address Total Amount Due Total Amount Rec'd Refund Amount Balance Due $ $ $ $ Email and/or online requests for copies and/or certificates cannot be accepted at this time. Please complete both pages of this order form. NPSF Records Order Form (Rev. 04/2015) Page 2 of 2 California Secretary of State www.sos.ca.gov (916) 653-3984 American LegalNet, Inc. www.FormsWorkFlow.com