Domestic Nonprofit Corporation Initial Report Form - Nm Public Regulation Commission

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RETURN TO:
DOMESTIC NONPROFIT CORPORATION
NM PUBLIC REGULATION COMMISSION
CORPORATIONS BUREAU
st
INITIAL REPORT (1
)
P.O. BOX 1269
For taxable year ending ____/____/_____
SANTA FE NM 87504-1269
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 identify every title each director holds.
A New Mexico 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 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)
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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