Annual Report Form - South Dakota Secretary Of State
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1FILE DATE ____________
ANNUAL REPORT
RECEIPT NO. __________
FOREIGN
Clear Form
PLEASE TYPE OR USE BLACK INK
FILING FEE: $30 MAKE CHECK PAYABLE TO SECRETARY OF STATE
Print
1. Corporate Name and Mailing Address:
Telephone # _________________________
FAX # ______________________________
FILING DATE: Due during the month the
Certificate of Authority was issued, and delinquent
after the last day of the following month.
ATTENTION - FILING INSTRUCTIONS
If ALL of the information is identical as set forth in the prior report, you may check the box below and sign the report.
ANY CHANGE requires full completion of the form.
ALL OF THE INFORMATION REQUIRED ON THE ANNUAL REPORT IS IDENTICAL AS SET FORTH IN THE PRIOR REPORT.
_____________________________________________________
2. It is incorporated under the laws of ______________________________________ and the address of its principal office in the state
of incorporation is__________________________________________________________________ Zip + 4 __________________
3. The address of its registered office in South Dakota is ______________________________________________________________
________________________________________________________________________________ Zip + 4 __________________
and the name of its registered agent at that address is______________________________________________________________
4. Provide a brief description of the nature of the business_____________________________________________________________
_________________________________________________________________________________________________________
5. The names and business addresses of its directors and principal officers:
NAME
OFFICE
STREET ADDRESS
CITY
STATE
ZIP+4
_____________________________ Director ___________________________________________________________________
_____________________________ Director ___________________________________________________________________
_____________________________ President __________________________________________________________________
_____________________________ Vice President ______________________________________________________________
_____________________________ Secretary __________________________________________________________________
_____________________________ Treasurer __________________________________________________________________
6. The total number of authorized shares, itemized by class and series, if any, within each class:
NUMBER OF AUTHORIZED SHARES
CLASS
SERIES
7. NUMBER OF ISSUED AND OUTSTANDING SHARES
CLASS
SERIES
The statement may be signed by any authorized officer of the Corporation.
Dated ________________________________
____________________________________________________
Signature
___________________________________________________
Printed Name
____________________________________________________
Title
RETURN TO: SECRETARY OF STATE, 500 E. CAPITOL, PIERRE, S.D. 57501-5077
PHONE: 605-773-4845
foreignannualreport July 2006
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