DOMESTIC NONPROFIT CORPORATION
NM PUBLIC REGULATION COMMISSION
INITIAL REPORT (1
P.O. BOX 1269
For taxable year ending ____/____/_____
SANTA FE NM 87504-1269
See instructions on back of page.
City, State, Zip
PRINCIPAL PLACE OF BUSINESS IN NEW MEXICO
NMPRC Certificate of Incorporation Number
REGISTERED AGENT AND OFFICE LOCATION WITHIN NEW MEXICO FOR SERVICE OF PROCESS
(Filing corporation cannot be its own agent)
BRIEF STATEMENT OF CHARACTER OF AFFAIRS BEING CONDUCTED
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.
Attach schedule of additional directors and officers if needed
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.
PAYMENT OF FILING FEE AND LATE FILING PENALTY
NMPRC USE ONLY
Report filing fee
Late filing penalty ($10.00)
PRC extension, if any, must be submitted with this report
TOTAL AMOUNT DUE with corporate report (lines a + b)
PLEASE DO NOT SUBMIT CASH FOR PAYMENT