Form 631 - Non-Profit Corporation 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
NON-PROFIT CORPORATION ANNUAL REPORT FOR THE YEAR __________
401.222.3040
June 1 - June 30
• Filing Fee: $20.00* • THIS REPORT MUST BE TYPED OR PRINTED LEGIBLY IN BLACK INK.
Filing Period:
* In accordance with R.I.G.L. 7-6-94, each corporation failing or refusing to file its annual report within the time prescribed by law (R.I.G.L. 7-6-91) is subject to a
penalty fee of $25.00.
1. Corporate ID No.
2. Name of Corporation
3. State of Incorporation
4. Corporate address in Rhode Island - Street Address
City
Zip
5. Foreign corporation. Enter principal office address
City
State
Zip
6. Brief Description of the character of the affairs which are actually conducted in Rhode Island
7. NAMES AND ADDRESSES OF THE OFFICERS:
FILL IN SPACES BEFORE USING ATTACHMENTS
(“X” BOX FOR ATTACHMENT)
President Name
Vice President Name
Street Address
Street Address
City
State
Zip
City
State
Zip
Secretary Name
Treasurer Name
Street Address
Street Address
City
State
Zip
City
State
Zip
8. NAMES AND ADDRESSES OF THE DIRECTORS:
FILL IN SPACES BEFORE USING ATTACHMENTS
(“X” BOX FOR ATTACHMENT)
THE NUMBER OF DIRECTORS OF A DOMESTIC (RHODE ISLAND) CORPORATION SHALL NOT BE LESS THAN THREE (3). R.I.G.L. 7-6-23
Director Name
Director Name
Street Address
Street Address
City
State
Zip
City
State
Zip
Director Name
Director Name
Street Address
Street Address
City
State
Zip
City
State
Zip
9. REGISTERED AGENT IN RHODE ISLAND
This information is currently of record in the Office of the Secretary of State. Changes require filing of Form 641 - R.I.G.L. 7-6-13/7-6-78
This report must be signed by either the President, Vice President, Secretary, Assistant Secretary, Treasurer, Receiver or Trustee
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 ________________________________________
Signature of Officer
Date
Check No. ________________________________________
Print or Type Name of Officer
By: ______________________________________________
FOR SECRETARY OF STATE USE ONLY
Title of Officer
Form 631 Rev. 09/17
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