Business Corporation Annual Report - North Carolina Secretary Of State
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1BUSINESS CORPORATION
ANNUAL REPORT
NAME OF CORPORATION:
STATE OF INCORPORATION: _______
SECRETARY OF STATE CORP. ID NUMBER: __________________
FISCAL YEAR ENDING: ____________________________
MONTH/DAY/YEAR
FEDERAL EMPLOYER ID NUMBER: _____-________________________
IF THIS IS THE INITIAL ANNUAL REPORT FILING, YOU MUST COMPLETE THE ENTIRE FORM. IF YOUR
BUSINESS CORPORATION’S INFORMATION HAS NOT CHANGED SINCE THE PREVIOUS REPORT,
PLEASE CHECK THE BOX AND COMPLETE LINE 8 ONLY.
1. REGISTERED AGENT & REGISTERED OFFICE MAILING ADDRESS:
2. STREET ADDRESS AND COUNTY OF REGISTERED OFFICE:
3. IF THE REGISTERED AGENT CHANGED, SIGNATURE OF THE NEW AGENT: __________________________________________________
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
4. ENTER PRINCIPAL OFFICE ADDRESS HERE:
ADDRESS-
CITY-
ST-
ZIP-
5. ENTER PRINCIPAL OFFICE TELEPHONE NUMBER HERE: ______________________________________
PLEASE INCLUDE AREA CODE
6. ENTER NAME, TITLE, AND BUSINESS ADDRESS OF PRINCIPAL OFFICERS HERE:
NAME-
ADDRESS-
TITLE-
CITY-
ST-
ZIP-
NAME-
ADDRESS-
TITLE-
CITY-
ST-
ZIP-
NAME-
ADDRESS-
TITLE-
CITY-
ST-
ZIP-
7. BRIEFLY DESCRIBE THE NATURE OF BUSINESS:
8. CERTIFICATION OF ANNUAL REPORT MUST BE COMPLETED BY ALL CORPORATIONS
_________________________________________________________
_____________________________________
FORM MUST BE SIGNED BY AN OFFICER OF CORPORATION
DATE
_________________________________________________________
_____________________________________
TYPE OR PRINT NAME
TYPE OR PRINT TITLE
ANNUAL REPORT FEE: $20.00 MAIL TO: Secretary of State • Corporations Division • Post Office Box 29525 • Raleigh, NC 27626-0525
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