Form HCD OL15 "Notice of Change of Corporate Officer(S), Director(S) and/or Controlling Stockholder(S)" - California

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What Is Form HCD OL15?

This is a legal form that was released by the California Department of Housing & Community Development - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2009;
  • The latest edition provided by the California Department of Housing & Community Development;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form HCD OL15 by clicking the link below or browse more documents and templates provided by the California Department of Housing & Community Development.

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Download Form HCD OL15 "Notice of Change of Corporate Officer(S), Director(S) and/or Controlling Stockholder(S)" - California

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STATE OF CALIFORNIA
BUSINESS, CONSUMER SERVICES AND HOUSING AGENCY
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
DIVISION OF CODES AND STANDARDS
OCCUPATIONAL LICENSING PROGRAM
NOTICE OF CHANGE OF CORPORATE OFFICER(S), DIRECTOR(S) AND/OR CONTROLLING STOCKHOLDER(S)
SECTION 1 – LICENSE INFORMATION
(Type or Print)
LICENSE NUMBER: ______________________________
TELEPHONE NUMBER: ( ____ ) __________________
CORPORATE NAME: ______________________________________________________________________________
DOING BUSINESS AS NAME (DBA)
: _________________________________________________________
(If applicable)
CORPORATE ADDRESS: ___________________________________________________________________________
Number and Street
City
State
ZIP Code
MAILING ADDRESS
: _______________________________________________________________________
(If different)
Number and Street or P. O.
City
State
ZIP Code
E-MAIL ADDRESS (If applicable): _____________________________________________________________________
SECTION 2 – TYPE OF CHANGE
Check appropriate box(es)
□
REMOVING OFFICER(S)/DIRECTOR(S)/CONTROLLING STOCKHOLDER(S):
•
Complete Sections 3, 5 and 7, and submit the form with the $72 fee specified in California Code of
Regulations, Title 25, Chapter 4, Section 5040.
•
Attach a copy of the corporate minutes evidencing the change.
□
ADDING OFFICER(S)/DIRECTOR(S)/CONTROLLING STOCKHOLDER(S):
•
Complete Sections 4, 5, 6 and 7, and submit the form with the $130 fee specified in California Code of
Regulations, Title 25, Chapter 4, Section 5040.
•
Attach a copy of the corporate minutes evidencing the change.
NOTE: IF YOU ARE REMOVING AND ADDING OFFICER(S)/DIRECTOR(S)/CONTROLLING STOCKHOLDER(S)
PLEASE SUBMIT BOTH FEES.
SECTION 3 – REMOVED OFFICER(S)/DIRECTOR(S)/CONTROLLING STOCKHOLDER(S)
(Type or Print)
The following person(s) is/are no longer corporate officer(s), director(s) and/or controlling stockholder(s):
FULL NAME
TITLE
EFFECTIVE DATE
□
CHECK IF ADDITIONAL PAGE(S) IS/ARE ATTACHED TO PROVIDE THE REQESTED INFORMATION
SECTION 4 – NEW OFFICER(S)/DIRECTOR(S)/CONTROLLING STOCKHOLDER(S)
(Type or Print)
The following new corporate officer(s) and/or director(s) has/have been appointed or elected, or new controlling
stockholder(s) has/have been acquired:
FULL NAME
TITLE
EFFECTIVE DATE
□
CHECK IF ADDITIONAL PAGE(S) IS/ARE ATTACHED TO PROVIDE THE REQUESTED INFORMATION
Page 1 of 2
HCD OL 15 (Rev. 08/20)
STATE OF CALIFORNIA
BUSINESS, CONSUMER SERVICES AND HOUSING AGENCY
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
DIVISION OF CODES AND STANDARDS
OCCUPATIONAL LICENSING PROGRAM
NOTICE OF CHANGE OF CORPORATE OFFICER(S), DIRECTOR(S) AND/OR CONTROLLING STOCKHOLDER(S)
SECTION 1 – LICENSE INFORMATION
(Type or Print)
LICENSE NUMBER: ______________________________
TELEPHONE NUMBER: ( ____ ) __________________
CORPORATE NAME: ______________________________________________________________________________
DOING BUSINESS AS NAME (DBA)
: _________________________________________________________
(If applicable)
CORPORATE ADDRESS: ___________________________________________________________________________
Number and Street
City
State
ZIP Code
MAILING ADDRESS
: _______________________________________________________________________
(If different)
Number and Street or P. O.
City
State
ZIP Code
E-MAIL ADDRESS (If applicable): _____________________________________________________________________
SECTION 2 – TYPE OF CHANGE
Check appropriate box(es)
□
REMOVING OFFICER(S)/DIRECTOR(S)/CONTROLLING STOCKHOLDER(S):
•
Complete Sections 3, 5 and 7, and submit the form with the $72 fee specified in California Code of
Regulations, Title 25, Chapter 4, Section 5040.
•
Attach a copy of the corporate minutes evidencing the change.
□
ADDING OFFICER(S)/DIRECTOR(S)/CONTROLLING STOCKHOLDER(S):
•
Complete Sections 4, 5, 6 and 7, and submit the form with the $130 fee specified in California Code of
Regulations, Title 25, Chapter 4, Section 5040.
•
Attach a copy of the corporate minutes evidencing the change.
NOTE: IF YOU ARE REMOVING AND ADDING OFFICER(S)/DIRECTOR(S)/CONTROLLING STOCKHOLDER(S)
PLEASE SUBMIT BOTH FEES.
SECTION 3 – REMOVED OFFICER(S)/DIRECTOR(S)/CONTROLLING STOCKHOLDER(S)
(Type or Print)
The following person(s) is/are no longer corporate officer(s), director(s) and/or controlling stockholder(s):
FULL NAME
TITLE
EFFECTIVE DATE
□
CHECK IF ADDITIONAL PAGE(S) IS/ARE ATTACHED TO PROVIDE THE REQESTED INFORMATION
SECTION 4 – NEW OFFICER(S)/DIRECTOR(S)/CONTROLLING STOCKHOLDER(S)
(Type or Print)
The following new corporate officer(s) and/or director(s) has/have been appointed or elected, or new controlling
stockholder(s) has/have been acquired:
FULL NAME
TITLE
EFFECTIVE DATE
□
CHECK IF ADDITIONAL PAGE(S) IS/ARE ATTACHED TO PROVIDE THE REQUESTED INFORMATION
Page 1 of 2
HCD OL 15 (Rev. 08/20)
SECTION 5 – CORPORATE STRUCTURE AFTER OFFICER(S)/DIRECTOR(S)/CONTROLLING STOCKHOLDER(S)
CHANGE
(Type or Print)
List the corporate officer(s), director(s) and controlling stockholder(s) below (include designated managing employee,
if applicable.) In Column A, indicate with an “X” those persons who will participate in the direction, control and/or
management of the manufacturing or sales operations of the business.
COLUMN A
FULL NAME (First, Middle, Last)
TITLE
RESIDENCE ADDRESS
□
CHECK IF ADDITIONAL PAGE(S) IS/ARE ATTACHED TO PROVIDE THE REQUESTED INFORMATION
SECTION 6 – LICENSING REQUIREMENTS
Each person indicated in Column A in Section 5 designated as participating in the direction, control and/or
management of the manufacturing or sales operations of the business, that has not done so previously, must submit
the following as an attachment to this form:
1. Application for MH-Unit/Commercial Modular Manufacturers, Distributors, Dealers and Salespersons, Part B
(Form HCD OL 29).
2. A properly completed HCD OL 8016 Live Scan form, unless exempted by the California Department of Justice
(DOJ). Only approved DOJ Live Scan facilities may be used. See DOJ’s website for approved facilities at
https://oag.ca.gov/fingerprints/locations. If there are no live scan facilities available in your area or for out of
state applicants, please contact the California Department of Housing and Community Development (HCD) at
(800) 952-8356 for directions and fingerprint cards. Applicants must pay the live scan operator directly for
fingerprint scanning.
3. Two (2) full facial photographs, minimum size 1¼” x 1”, taken from a maximum distance of six (6) feet.
4. Proof (HCD examination receipt) of successful completion of the MH-Unit or Commercial Modular Dealer
Examination.
NOTE: FOR MH-UNIT DEALERS ONLY, PRELIMINARY EDUCATION REQUIREMENTS
MUST BE MET PRIOR TO APPLYING FOR THE EXAMINATION.
SECTION 7 – CERTIFICATION
I, ______________________________________________________________________, Secretary of the Corporation,
Type or Print First and Last Name
certify under penalty of perjury under the laws of the State of California that the foregoing and any attachments hereto for
Sections 3, 4, and 5 are true and correct, and that the California Secretary of State has been notified of the changes listed
herein as applicable, and that as Secretary of the Corporation, I am the official custodian of the records of this corporation,
and have the authority to affix the corporate seal.
A
F
F
I
X
C
O
R
P
O
R
A
T
E
S
E
A
L
________________________________________
A A
F F
F F
I I
X X
C C
O O
R R
P P
O O
R R
A A
T T
E E
S S
E E
A A
L L
Signature of Secretary of Corporation
________________________________________
Date
Page 2 of 2
HCD OL 15 (Rev. 08/20)
California Department of Housing & Community Development California Legal Forms United States Legal Forms

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