Annual Farm Report Form Limited Liability Company - Secretary Of State

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RETURN TO:

FILE DATE ________________

ANNUAL FARM REPORT

SECRETARY OF STATE

RECEIPT NO. ______________

STATE CAPITOL

Limited Liability Company

500 E. CAPITOL AVE.

Clear Form

PIERRE, S.D. 57501

PLEASE TYPE OR USE BLACK INK

NO FILING FEE

(605)773-4845

Fax (605)773-4550

FILING DATE: Due during the month the Certificate of

organization was issued, and delinquent the last day of the

following month.

Pursuant to the provisions of SDCL 47-9A, the undersigned Limited Liability Company hereby submits the following farming annual report:

1. The name of the Limited Liability Company is

The state of organization is

2. The name of the registered agent in South Dakota and the registered office address is

Zip + 4

3. If a foreign Limited Liability Company, the address of its principal office, or registered office in its state of organization is

4. List only the changes since the last report of the acreage and location by section, township, and county of each lot or parcel of land in this state

owned or leased by the Limited Liability Company.

5. List only the changes of the names or addresses of the members and/or manager(s).

NAME

REPLACED

AS MEMBERS OR MANAGER

6. The

owned by person(s) residing on the farm or actively operating the farm, or who has

NUMBER OF MEMBERSHIP INTERESTS

resided on or has actively operated the farm, or their relatives within the third degree of kindred, or by resident members who are family farmers

and are actively engaged in farming as their primary economic activity is

(Degree of kindred is defined

as number of generations with each generation being a degree.) #6 applies only to FAMILY FARM.