Domestic Nonprofit Corporation Annual Or Supplemental Report Form - Nm Public Regulation Commission

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RETURN TO:
DOMESTIC NONPROFIT CORPORATION
NM PUBLIC REGULATION COMMISSION
CORPORATIONS BUREAU
ANNUAL REPORT_________ For taxable year ending ____/____/_____
P.O. BOX 1269
OR
SANTA FE NM 87504-1269
SUPPLEMENTAL REPORT________( if any information changes)
See instructions on back of page.
1
EXACT
Name
CORPORATE
NAME
Address
AND
U.S. MAILING
City, State, Zip
ADDRESS
2
PRINCIPAL PLACE OF BUSINESS IN NEW MEXICO
3
NMPRC Certificate of Incorporation Number
Street
City, Zip
4
REGISTERED AGENT AND OFFICE LOCATION WITHIN NEW MEXICO FOR SERVICE OF PROCESS
(Filing corporation cannot be its own agent)
Name
Street Address
City, Zip
5
BRIEF STATEMENT OF CHARACTER OF AFFAIRS BEING CONDUCTED
6
DIRECTORS AND OFFICERS List the names and addresses of ALL the directors and officers and identify every title each
director holds. A New Mexico non-profit corporation shall have not less than 3 directors.
(optional)
Office/Title
Name
Address
Additional Titles
Director
Director
Director
President
Vice President
Secretary
Treasurer
Attach schedule of additional directors and officers if needed
7
SIGNATURES 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.
Date
Printed Name
Signature
Title
8
PAYMENT OF FILING FEE AND LATE FILING PENALTY
NMPRC USE ONLY
a
Report filing fee
$ 10.00
b
Late filing penalty ($10.00) except supplemental
IRS or PRC extension, if any, must be submitted with this report
Amount Remitted
Postmark Date
c
TOTAL AMOUNT DUE with corporate report (lines a + b)
$
PLEASE DO NOT SUBMIT CASH FOR PAYMENT

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