Annual Report Domestic Nonprofit Form - South Dakota Secretary Of State - 2008

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ANNUAL REPORT
Secretary of State Office
500 E Capitol Ave
FILE DATE
____________________
DOMESTIC NONPROFIT
Pierre, SD 57501
RECEIPT NO ___________________
(605)773-4845
Please Type or Print Clearly in Ink
Clear Form
FILING FEE: $10
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 Incorporation was
issued, and delinquent after the last
day of the following month.
2. 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
3. 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
4. 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. South Dakota Law requires at least three directors.
_____________________________________________________________________________________________
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
_____________________________________________________________________________________________
Director
Street Address
City
State
ZIP+4
Dated ____________________________
______________________________________________
(Signature of an authorized officer)
______________________________________________
(Printed Name)
______________________________________________
(Title)
Annualreportdomesticnonprofit July2008

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