Annual Report Domestic L.l.c. Form
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SECRETARY OF STATE
FILE DATE ________________
STATE CAPITOL
RECEIPT NO. ______________
500 E. CAPITOL AVE.
PIERRE, S.D. 57501
ANNUAL REPORT
HELP
(605)773-4845
DOMESTIC L.L.C.
Fax (605)773-4550
PLEASE TYPE OR USE BLACK INK
F
ILING FEE: $50
ADDITIO
NAL PENALTY FEE OF $50 APPLIES TO ALL LATE FILINGS
1. L.L.C. Name, Registered Agent and Mailing Address:
Telephone # __________________________
FAX # ______________________________
Federal Taxpayer ID # __________________
FILING DATE: Due during the month the
Certificate of Organization was issued, and
delinquent after the last day of the following
month.
2. The state or country under whose law it is organized is: ____________________________________________________________
3. The address of its registered office and the name of its registered agent for service of process in South Dakota is:
4. The address of its principal office is: ___________________________________________________________________________
5. The names and business addresses of any managers:
6. The dollar amount of the total agreed contributions to the Limited Liability Company is $ _______________________________.
The information must be current as of the date the annual report is signed on behalf of the limited liability company. The annual report
must be signed by a manager of a manager-managed company, or a member of a member-managed company. It must state adjacent to
the signature the name and capacity of the signer.
Date: __________________
________________
____________________________________
(Signature)
____________________________________________________
(Title)
revised 10/04
1.
PRINT FOR MAILING
2.
EXIT
CLEAR FORM
DBLLCAR.DOC
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