Biennial Or Supplemental Report Form - Domestic Profit Corporation - Nm Public Regulation Commission
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1DOMESTIC PROFIT CORPORATION
RETURN TO:
NM PUBLIC REGULATION COMMISSION
BIENNIAL REPORT_______ For taxable year ending_____/____/_______
CORPORATIONS BUREAU
OR
P.O. BOX 1269
SUPPLEMENTAL REPORT_______( if any information changes)
SANTA FE NM 87504-1269
Please see instructions on back of page.
1
Name
EXACT
CORPORATE
NAME
Address
AND
U.S. MAILING
City, State, Zip
ADDRESS
2
NMPRC Certificate of Incorporation No.
3
Principal Place of Business in New Mexico
Street
City, Zip
4
REGISTERED AGENT AND OFFICE LOCATION WITHIN NEW MEXICO FOR SERVICE OF PROCESS
(Filing corporation cannot be its own agent)
Name
Street Address
City, Zip
5
TAX ID NUMBER
6
NEXT ANNUAL MEETING
7
DIRECTORS AND OFFICERS List the names and addresses of ALL the directors and officers and identify every title each
director holds. A New Mexico corporation shall consist of 1 or more directors.
(optional)
Term
Office/Title
Name
Address
Additional Titles
Expires
Director
Director
Director
President
Vice President
Secretary
Treasurer
8
SIGNATURE Under penalties of perjury, I declare and affirm that I have examined this report, including the accompanying
schedules and statements, and that all statements contained therein are true and correct.
Date
Printed Name
Signature
Title
9
PAYMENT OF FILING FEE AND LATE FILING PENALTY
NMPRC USE ONLY
a Report filing fee
$ 25.00
b Late filing penalty ($200.00) except supplemental
IRS or PRC extension, if any, must be submitted with this report
Amount Remitted
Postmark Date
c TOTAL AMOUNT DUE with corporate report (lines a + b)
$
PLEASE DO NOT SUBMIT CASH FOR PAYMENT
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