Annual Report-South Dakota Secretary Of State Form
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1ANNUAL REPORT
FILE DATE ___________
RECEIPT NO. _________
DOMESTIC
Clear Form
PLEASE TYPE OR USE BLACK INK
FILING FEE: $30 MAKE CHECK PAYABLE TO SECRETARY OF STATE
Print
1. Corporate Name, Registered Agent Name and Registered Address:
Telephone # _________________________
FAX # ______________________________
FILING DATE: Due during the month the
Certificate of Incorporation was issued, and
delinquent after the last day of the following
month.
ATTENTION - FILING INSTRUCTIONS
If ALL of the information, including the registered agent and address listed in number one is identical as set forth in the prior report, you
may check the box below and sign the report. To report a change in the registered agent and/or office, a statement of change must be
filed. Any change requires full completion of this form.
ALL OF THE INFORMATION REQUIRED ON THE ANNUAL REPORT IS IDENTICAL AS SET FORTH IN THE PRIOR REPORT.
2. The address of the principal office______________________________________________________________________________
3. The names and business addresses of its directors and principal officers:
NAME
OFFICE
STREET ADDRESS
CITY
STATE
ZIP+4
_____________________________ President __________________________________________________________________
_____________________________ Vice President ______________________________________________________________
_____________________________ Secretary __________________________________________________________________
_____________________________ Treasurer __________________________________________________________________
4. Provide a brief description of the nature of the business_____________________________________________________________
SD law requires at least one director.
Do the above listed officers serve also as directors? YES ___ NO ___ If no, list directors below.
_____________________________ Director ___________________________________________________________________
_____________________________ Director ___________________________________________________________________
5. The total number of authorized shares, itemized by class and series, if any, within each class:
NUMBER OF AUTHORIZED SHARES
CLASS
SERIES
_______________________________
_________
___________
_______________________________
_________
___________
6. NUMBER OF ISSUED AND OUTSTANDING SHARES
CLASS
SERIES
_______________________________
_________
___________
_______________________________
_________
___________
The statement may be signed by any authorized officer of the Corporation.
Dated ________________________________
____________________________________________________
Signature
____________________________________________________
Printed Name
____________________________________________________
Title
RETURN TO: SECRETARY OF STATE, 500 E. CAPITOL, PIERRE, S.D. 57501-5077
PHONE: 605-773-4845
domesticannualreport July 2006
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