Form Npd-01 - Articles Of Incorporation 2015 Page 2
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1
2Arkansas Secretary of State
M
M
ark
artin
1401 W. Capitol, Suite 250, Little Rock, AR 72201
501-682-3409 •
Annual Report – Contact Information
Nonprofit Corporation
PLEASE TYPE OR PRINT CLEARLY IN INK
JURISDICTION (SELECT ONE)
Domestic
Foreign
In order for this entity to receive its annual reporting form, please complete and file with the Office of the Secretary of
State at the time of filing.
_____________________________________________________
__________________________________________________
Entity name as used in Arkansas
Contact Person
_____________________________________________________
__________________________________________________
Street Address or Post Office Box Number
City, State Zip
_____________________________________________________
__________________________________________________
Telephone Number
E-mail Address
st
NOTE: Annual Reports will be due on or before August 1
the year following filing or qualification in this state.
I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class
C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.
Executed this ___________ day of _____________, __________________.
_____________________________________________________
__________________________________________________
Signature
Authorized Officer (Type or Print)
NPD-01 Rev. 07/15
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