ANNUAL REPORT
FILE DATE
____________________
Enter Filing Year
DOMESTIC LLP
Secretary of State Office
RECEIPT NO ___________________
500 E Capitol Ave
Please Type or Print Clearly in Ink
Clear Form
Pierre, SD 57501
FILING FEE: $50
SECRETARY OF STATE
Make check payable to
(605)773-4845
1
L.L.P. ID and Name:
.
Search for Corporate ID, Name and Agent
Telephone # ____________________
South Dakota
2. The jurisdiction under whose law it is formed __________________________________________________________
3. The address of the principal or chief executive office.
______________________________________________________________________________________________
Street Address
City
State
ZIP+4
______________________________________________________________________________________________
Mailing Address
City
State
ZIP+4
______________________________________________________________________________________________________________________
Email Address
IF ADDRESS IN #3 IS NOT A SOUTH DAKOTA ADDRESS QUESTION #4 IS REQUIRED.
4. The name of the South Dakota Registered Agent _______________________________________________________
______________________________________________________________________________________________
Street Address or Rural Route Box Number in This State and
City
State
ZIP+4
______________________________________________________________________________________________
Mailing Address in This State, if Different from Street Address
City
State
ZIP+4
______________________________________________________________________________________________________________________
Email Address
5. The names and addresses of its partners.
______________________________________________________________________________________________
Partner
Street Address
City
State
ZIP+4
______________________________________________________________________________________________
Partner
Street Address
City
State
ZIP+4
______________________________________________________________________________________________
Partner
Street Address
City
State
ZIP+4
______________________________________________________________________________________________
Partner
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)
*By signing this form you agree to have both the fee and the form processed electronically.
annualreportllp January 2011