Domestic Cooperative Periodic Registration - Minnesota Secretary Of State
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1MINNESOTA SECRETARY OF STATE
DOMESTIC COOPERATIVE PERIODIC REGISTRATION
Minnesota Statutes Chapter 308A
For your convenience, this form
Must be filed by December 31
has been designed to be
completed online. You must have
Acrobat Reader 5.0 or above to
use this new feature. Once your
READ INSTRUCTIONS ON BACK BEFORE COMPLETING THIS FORM
form is completed, be sure to
select "Print" at the bottom of the
FROM:
screen to capture your data entry
for printing. After printing, sign
and send applicable fees as
required.Note: Selecting "Reset"
will clear all data entry from this
page. To print a blank form, go to
File->Print.
CURRENT INFORMATION ON FILE:
1. File #:
2. Cooperative Name: (Required)
3. Registered Agent/ Registered Office Address: (Required)
Agents Name (if applicable)
Street:
City:
State:
Zip:
4. Principal Place of Business Address: (Required)
Address:____________________________________________________________________________________________
(PO Box not acceptable)
City:_____________________________________________________State:_______________________Zip____________
5. Name and Business Address of C.E.O.: (Required)
Name: _____________________________________________________________________________________________
Address:____________________________________________________________________________________________
City:_____________________________________________________State:_______________________Zip____________
6. Does this cooperative own, lease, or have any financial interest in agricultural land or land capable of being farmed?
____Yes ____ No
7. Name and daytime telephone number and/or e-mail address of contact person for the cooperative:
Name: _________________________________________________(____)_________________
Ext. __________
E-Mail Address: _______________________________________________________________________________
NOTICE: Failure to file this form by December 31 of this year will result in the dissolution of this cooperative
without further notice from the Secretary of State, pursuant to Minnesota Statutes, section 308A.995,
subdivision 4, paragraph (b).
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bus23 Domestic Cooperatice Periodic Reg. Rev. 8-05
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