Llc Annual Report Form - North Carolina Secretary Of State
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1LIMITED LIABILITY COMPANY (LLC)
ANNUAL REPORT
NAME OF LIMITED LIABILITY COMPANY:
STATE OF FORMATION: _______
FISCAL YEAR ENDING: ______________________________
MONTH/DAY/YEAR
SECRETARY OF STATE L.L.C. ID NUMBER: __________________
If this is the first annual report filing, YOU MUST COMPLETE THE ENTIRE FORM. If your
LLC’s information has not changed since the previous report, please check the box
and complete line 7.
1.
REGISTERED AGENT & REGISTERED OFFICE STREET ADDRESS—INCLUDE COUNTY: Must be a North Carolina address!
Name:____________________________________________________________________________________________________
Street____________________________________City______________NC, ZIP____________County_______________________
2. REGISTERED OFFICE MAILING ADDRESS IF DIFFERENT FROM THE STREET ADDRESS:
3. IF THE REGISTERED AGENT CHANGED, THE NEW AGENT MUST SIGN: _________________________________________________
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
4.
ENTER PRINCIPAL OFFICE ADDRESS AND TELEPHONE NUMBER HERE:
Street____________________________________City__________________ST______ZIP________________________
Telephone Number, including area code (
)_______________________________
5.
BRIEFLY DESCRIBE THE NATURE OF BUSINESS:
6.
ENTER NAME, TITLE, AND BUSINESS ADDRESS OF MANAGER(S)/MEMBER(S) OR IF THE LLC HAS NEVER HAD MEMBERS, ITS
ORGANIZERS: (ATTACH ADDITIONAL PAGES IF NECESSARY)
NAME-
BUSINESS ADDRESS-
NAME-
BUSINESS ADDRESS-
NAME-
BUSINESS ADDRESS-
7. CERTIFICATION OF ANNUAL REPORT MUST BE COMPLETED BY ALL LIMITED LIABILITY COMPANIES.
_______________________________________________________________________
_____________________________________
FORM MUST BE SIGNED BY A MANAGER/MEMBER
DATE
__________________________________________________
___
MANAGER/MEMBER_____________
TYPE OR PRINT NAME
TITLE
ANNUAL REPORT FEE: $200.00
MAIL TO: Secretary of State • Corporations Division • Post Office Box 29525 • Raleigh, NC 27626-0525
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