Nonprofit Corporate Report Form - New Mexico

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RETURN TO:
STATE CORPORATION COMMISSION
CORPORATION DEPARTMENT
P.O. BOX 1269, SANTA FE, NEW MEXICO 87504-1269
NONPROFIT CORPORATE REPORT
TO THE STATE CORPORATION COMMISSION OF NEW MEXICO
Please type or print legibly
>>_________________
SUPPLEMENTAL
Instructions on next page
________________________________________________________________________________________________________________
1. EXACT
CORPORATE
NAME
AND
U.S. MAILING
ADDRESS
_____________________________________________________________________________________________________________
2. PRINCIPAL PLACE OF BUSINESS IN NEW MEXICO
3. PRINCIPAL OFFICE OUTSIDE NEW MEXICO
4. NMSCC Certificate
(if different from registered office in state of incorp)
of Incorporation /
Authority Number
STREET ___________________________________
STREET _____________________________
CITY,ZIP ___________________________________
CITY,STATE,ZIP _______________________
refer to above number
in all correspondence
_____________________________________________
_______________________________________
____________________
5. NM Tax & Revenue ID
_____________________________________________
_______________________________________
____________________
_________________________________________________________________________________________________________________
6. FOREIGN CORPORATION - REGISTERED OFFICE IN STATE OF INCORPORATION
7. STATE OR COUNTRY
OF INCORPORATION
STREET __________________________________________________________________________
CITY,STATE,ZIP ___________________________________________________________________
____________________
_________________________________________________________________________________________________________________
8. REGISTERED AGENT AND OFFICE LOCATED WITHIN NEW MEXICO FOR SERVICE OF PROCESS
(filing corporation cannot be its own agent)
NAME _________________________________________________________________________________________________________
STREET _______________________________________________________________________________________________________
(post office box unacceptable unless geographical location is given)
CITY,ZIP _______________________________________________________________________________________________________
_________________________________________________________________________________________________________________
9. The names and addresses of ALL Officers and Directors of the Corporation are: (Refer to instruction No. 9 for additional information
requiring Officers identified accordingly as Directors, as the case may be. A New Mexico Corporation shall have not less than three
directors.)
OFFICE/TITLE
NAME AND ADDRESS
_____________________
__________________________________________________________________________________________
_____________________
__________________________________________________________________________________________
Director __________________________________________________________________________________________________________
Director __________________________________________________________________________________________________________
Director __________________________________________________________________________________________________________
(attach schedule if needed)
The character of its business in New Mexico, briefly stated, is _______________________________________________________________
_________________________________________________________________________________________________________________
10. Under penalties of perjury, we declare and affirm that we have examined this report, including the accompanying schedules and
statements and that all statements contained therein are true and correct.
Dated _________________
______________________________________________________________________________
(signature and title)
______________________________________________________________________________
(signature and title)
The Report shall be signed and sworn to by any two of its directors or officers. If the corporation is in the hands of a receiver or trustee, the
Report shall be executed on behalf of the corporation by the receiver or trustee.
________________________________________________________________________________________________________________
11.
PAYMENT OF FILING FEE AND LATE FILING PENALTY:
NMSCC Office Use Only
(a) Filing fee due on Corporate Report…………………………………….…(a) $
10.00
(b) Ten Dollars Late Filing Fee Penalty………………………………………(b) $
_____________________
(IRS or SCC Valid extension, if any, must be submitted
____________
Amount
Postmark
with report at time of submission)
Remitted
Date
(c) TOTAL AMOUNT DUE WITH CORPORATE REPORT (lines a+b)....(c) $
PLEASE DO NOT SUBMIT CASH FOR PAYMENT
_____________
______________________

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