ANNUAL REPORT
Receipt No _________________
D
B
C
Enter Filing Year
OMESTIC
USINESS
ORPORATION
Secretary of State Office
SDCL 59-11-24, 24.1
500 E Capitol Ave
Pierre, SD 57501
FILING FEE: $50
(605) 773-4845
SECRETARY OF STATE
Make check payable to
Effective July 1st, 2016: Late Fee: $50 / Paper Filing Fee: $15
1. Business ID and Name:
Telephone # ________________
Business ID
Business Name
South Dakota
2. The jurisdiction under whose law it is formed
3. The address of the principal executive office (business address).
Actual Street Address
City
State
ZIP+4
Mailing Address, if Different from Street Address
City
State
ZIP+4
Email Address (Optional)
4. The South Dakota Registered Agent’s name
South Dakota law permits the registered agent to be either a noncommercial registered agent (this may be an
individual) ((a) below), a commercial registered agent ((b) below), or an office holder ((c) below). Complete only one
below, either (a) or (b) or (c).
(a) The South Dakota Noncommercial Registered Agent’s name
Actual Street Address in this State
City
State
ZIP+4
Mailing Address in this State, if Different from Street Address
City
State
ZIP+4
Email Address (Optional)
(b) When listing a Commercial Registered Agent, please state their CRA#. This number can be obtained from the
Commercial Registered Agent.
Name: _________________________________________________
CRA#: _________________________________________________
(c) Title of the office or other position with the corporation
Business Office’s Actual Street Address in this State
City
State
ZIP+4
Email Address (Optional)
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