Form 632 - Limited Liability Company Annual Report
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1State of Rhode Island
and Providence Plantations
A. Ralph Mollis, Secretary of State
Corporations Division
Click here for instruction page
148 W. River Street
Office of the Secretary of State
Providence, RI 02904-2615
401.222.3040
LIMITED LIABILITY COMPANY ANNUAL REPORT FOR THE YEAR ____________
Filing Period: September 1 - November 1 • Filing Fee: $50.00* • THIS REPORT MUST BE TYPED OR PRINTED LEGIBLY IN BLACK INK.
* In accordance with R.I.G.L. 7-16-66 (d), each limited liability company failing or refusing to file its annual report within thirty (30) days after the time prescribed by law
(R.I.G.L. 7-16-66 (b&c)) is subject to a penalty fee of $25.00.
1. ID No.
2. Exact name of the limited liability company
3. State of Formation
4. Brief description of the character of the business which is actually conducted in Rhode Island
5. Principal office address
City
State
Zip
6. MAILING ADDRESS OF LIMITED LIABILITY COMPANY AND NAME OR TITLE OF CONTACT PERSON:
Contact Name
Contact Title
Street Address
City
State
Zip
7. NAME AND ADDRESS OF EACH MANAGER OF THE LIMITED LIABILITY COMPANY, IF APPLICABLE -
DO NOT LIST MEMBERS
(“X” BOX FOR ATTACHMENT)
FILL IN SPACES BEFORE USING ATTACHMENTS
Manager Name
Manager Name
Street Address
Street Address
City
State
Zip
City
State
Zip
Manager Name
Manager Name
Street Address
Street Address
City
State
Zip
City
State
Zip
8. RESIDENT AGENT IN RHODE ISLAND
This information is currently of record in the Office of the Secretary of State. Changes require filing of Form 642 - R.I.G.L. 7-16-11
This report must be executed by an authorized person pursuant to R.I.G.L. 7-16-66 (b).
Under penalty of perjury, I declare and affirm that I have examined this report,
including any accompanying schedules and statements, and that all statements
contained herein are true and correct.
File Date ________________________________________
Check No. ________________________________________
Signature of Authorized Person
Date
By: ______________________________________________
Print or Type Name of Authorized Person
FOR SECRETARY OF STATE USE ONLY
Form 632 Rev. 08/08
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