Annual Report Foreign Corporation Form - South Dakota Secretary Of State
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1ANNUAL REPORT
FILE DATE
Enter Filing Year
FOREIGN CORPORATION
Secretary of State Office
RECEIPT NO
SDCL 59-11-24
500 E Capitol Ave
Pierre, SD 57501
Please Type or Print Clearly in Ink
FILING FEE: $50
(605) 773-4845
SECRETARY OF STATE
Make check payable to
1. Corporate ID and Name:
Enter Corporate ID
Telephone #
Enter Corporate Name
2. The jurisdiction under whose law it is formed
3. The address of the principal executive office (business address).
Actual Street Address or Rural Route Box Number
City
State
ZIP+4
Mailing Address, if Different from Street Address
City
State
ZIP+4
Email Address (Optional)
4. The name of the South Dakota Registered Agent
Actual Street Address or Rural Route Box Number in this State
City
State
ZIP+4
Mailing Address in this State, if Different from Street Address
City
State
ZIP+4
Email Address (Optional)
5. The names and business addresses of its principal officers and directors (governors). If, pursuant to SDCL 47-1A-
732(1), the board of directors has been eliminated, list the names of the shareholders.
Shareholder/Governor
Actual Street Address
City
State
ZIP+4
Shareholder/Governor
Actual Street Address
City
State
ZIP+4
Shareholder/Governor
Actual Street Address
City
State
ZIP+4
Shareholder/Governor
Actual Street Address
City
State
ZIP+4
Shareholder/Governor
Actual Street Address
City
State
ZIP+4
Shareholder/Governor
Actual Street Address
City
State
ZIP+4
No person may execute this report knowing it is false in any material respect. Any violation is subject to a civil penalty.
Dated
(Signature of an Authorized Person)
Email
__
(Printed Name)
(Optional)
*By signing this form you agree to have both the fee and the form processed electronically.
A fee of up to $40 will be assessed for returned payments.
Annualreportforeign April 2015
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