18-D31436

LLC-12

Secretary of State
Statement of Information
(Limited Liability Company)

FILED

IMPORTANT — Read instructions before completing this form.

In the office of the Secretary of State
of the State of California

Filing Fee – $2 .00

OCT 02, 2018
Copy Fees – First page $1.00; each attachment page $0.50;
Certification Fee - $5.00 plus copy fees

This Space For Office Use Only

1. Limited Liability Company Name (Enter the exact name of the LLC. If you registered in California using an alternate name, see instructions.)

PROPERTY INVESTMENT HOUSING, LLC
2. 12-Digit Secretary of State File Number

201500810387

3. State, Foreign Country or Place of Organization (only if formed outside of California)

CALIFORNIA

4. Business Addresses
a. Street Address of Principal Office - Do not list a P.O. Box

City (no abbreviations)

274 LOYOLA AVE

CLOVIS

b. Mailing Address of LLC, if different than item 4a

City (no abbreviations)

274 LOYOLA AVE

CLOVIS

c. Street Address of California Office, if Item 4a is not in California - Do not list a P.O. Box

272 W Everglade ave
5. Manager(s) or Member(s)

City (no abbreviations)

Clovis

State

Zip Code

CA

93619-7522

State

Zip Code

CA

93619-7522

State

Zip Code

CA

93619

If no managers have been appointed or elected, provide the name and address of each member. At least one name and address
must be listed. If the manager/member is an individual, complete Items 5a and 5c (leave Item 5b blank). If the manager/member is
an entity, complete Items 5b and 5c (leave Item 5a blank). Note: The LLC cannot serve as its own manager or member. If the LLC
has additional managers/members, enter the name(s) and addresses on Form LLC-12A (see instructions).

a. First Name, if an individual - Do not complete Item 5b

Middle Name

STEPHANIE

MAIE

Last Name

Suffix

COSTA

b. Entity Name - Do not complete Item 5a
c. Address

274 LOYOLA AVE

City (no abbreviations)

State

CLOVIS

CA

Zip Code

93619-7522

6. Service of Process (Must provide either Individual OR Corporation.)
INDIVIDUAL – Complete Items 6a and 6b only. Must include agent’s full name and California street address.
a. California Agent's First Name (if agent is not a corporation)

Middle Name

Last Name

MARIE

STEPHANIE
b. Street Address (if agent is not a corporation) - Do not enter a P.O. Box

274 LOYOLA AVE

Suffix

COSTA

City (no abbreviations)

State

CLOVIS

CA

Zip Code

93619-7522

CORPORATION – Complete Item 6c only. Only include the name of the registered agent Corporation.
c. California Registered Corporate Agent’s Name (if agent is a corporation) – Do not complete Item 6a or 6b

7. Type of Business
a. Describe the type of business or services of the Limited Liability Company

Senior Care
8. Chief Executive Officer, if elected or appointed
a. First Name

Middle Name

Last Name

b. Address

Suffix

COSTA

MARIE

STEPHANIE

City (no abbreviations)

State

CA

CLOVIS

274 LOYOLA AVE

Zip Code

93619-7522

9. The Information contained herein, including any attachments, is true and correct.

10/02/2018

_____________________
Date

STEPHANIE MARIE COSTA

____________________________________________________________
Type or Print Name of Person Completing the Form

Administrator

_________________________
Title

__________________________________
Signature

Return Address (Optional) (For 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. This information will become public when filed. SEE INSTRUCTIONS BEFORE COMPLETING.)

Name:
Company:
Address:
City/State/Zip:
LLC-12 (REV 01/2017)

Page 1 of 1

2017 California Secretary of State

www.sos.ca.gov/business/be