Annual Report Foreign Cooperative Form - South Dakota Secretary Of State
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1ANNUAL REPORT
Secretary of State Office
500 E Capitol Ave
FILE DATE
____________________
FOREIGN COOPERATIVE
Pierre, SD 57501
RECEIPT NO ___________________
(605)773-4845
Please Type or Print Clearly in Ink
Clear Form
FILING FEE: $50
SECRETARY OF STATE
Make check payable to
1. Corporate ID and Name:
HELP
Search for Corporate ID, Name and Agent
Telephone # ____________________
FAX #
_______________________
FILING DATE: Due during the month
the Certificate of Authority was issued,
and delinquent after the last day of the
following month.
2. The jurisdiction under whose law it is formed ___________________________________________________________
3. The address of the principal executive office in or out of the State of South Dakota.
______________________________________________________________________________________________
Street Address
City
State
ZIP+4
______________________________________________________________________________________________
Mailing Address (Optional)
City
State
ZIP+4
4. The name of the South Dakota Registered Agent _______________________________________________________
______________________________________________________________________________________________
Street Address (Required to be a South Dakota Address)
City
State
ZIP+4
______________________________________________________________________________________________
Mailing Address (Optional – Required to be a South Dakota Address)
City
State
ZIP+4
5. The names and business addresses of its principal officers and directors. Please place a check mark next to the name
if the principal officer serves as a director.
_____________________________________________________________________________________________
President
Street Address
City
State
ZIP+4
_____________________________________________________________________________________________
Vice President
Street Address
City
State
ZIP+4
_____________________________________________________________________________________________
Secretary
Street Address
City
State
ZIP+4
_____________________________________________________________________________________________
Treasurer
Street Address
City
State
ZIP+4
_____________________________________________________________________________________________
Director
Street Address
City
State
ZIP+4
_____________________________________________________________________________________________
Director
Street Address
City
State
ZIP+4
_____________________________________________________________________________________________
General Manager
Street Address
City
State
ZIP+4
No person may execute this report knowing it is false in any material respect. Any violation is subject to a civil penalty.
Dated ____________________________
______________________________________________
(Signature of an Authorized Person)
______________________________________________
(Printed Name)
annualreportforeigncoop July 2010
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