Domestic Nonprofit Corporation Annual Report - Hawaiidepartment Of Commerce
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1STATE OF HAWAII
DOMESTIC NONPROFIT CORPORATION
RETURN ORIGINAL BY
FILING FEE: $ 5.00
DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS
BUSINESS REGISTRATION DIVISION
H
335 Merchant Street
Clear Form
Mailing Address: Annual Filing, P.O. Box 113600, Honolulu, HI. 96811
DOMESTIC NONPROFIT CORPORATION ANNUAL REPORT AS OF
CORPORATE NAME AND MAILING ADDRESS:
If the above mailing address has changed, line out and print change to the right.
If address of principal office differs from the above mailing address, state the address of principal office. Include City, State, and Zip
Code: _______________________________________________________________________________________________
1. The following is a brief description of the nature of activities which the corporation is actually conducting.
NATURE OF ACTIVITIES:
(To correct, line out and print corrections below. If inactive during the period, state INACTIVE.)
2. Street address of the registered office in Hawaii and the name of the registered agent at that address. (If any change, line out and print
change on the right. See reverse for instructions.) After any changes made, the street addresses of its registered office and agent shall
be identical.
3
(List all officers and directors. Every corporation must have a minimum of three directors.)
. OFFICERS/DIRECTORS:
OFFICE HELD/
DIRECTOR CODE
ADDRESS (INCLUDE CITY, STATE & ZIP CODE)
NAME IN FULL
NO CHANGES: Do not check this box if changes have been made above. (Checking this box means there are no
changes reported. The Department will not be held responsible for any changes made to this report
CERTIFICATION
I certify under the penalties of Section 414D-12, Hawaii Revised Statutes, that I have read the above, the information is true
and correct, and I am authorized to sign this report.
DATE:
Signature of authorized officer, attorney-in-fact
Print Name
for an officer, or receiver or trustee
(if the corporation is in the hands of a receiver or trustee)
FILE NO.
B18
Rev. 7/2007
B22
File this Original
(SEE REVERSE SIDE FOR INSTRUCTIONS)
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