W. Fox McKeithen
CORPORATION/LIMITED LIABILITY COMPANY SUPPLEMENTAL
Secretary of State
INITIAL REPORT
(R.S. 12:25 & R.S. 12:1305)
Enclose $25.00 filing fee
Return to: Commercial Division
Make remittance payable to
P. O. Box 94125
Secretary of State
Baton Rouge, LA 70804-9125
Do Not Send Cash
Phone (225) 925-4704
Web Site:
1. The name of this company is: _____________________________________________________________
2. The names and municipal addresses (not a P.O. Box only) of the first directors (corporation) or
managers or members (limited liability company) are:
Name
Address
Name
Address
Name
Address
Name
Address
Corporations:
To be signed by incorporator(s) or shareholder(s):
LLC:
To be signed by each person who signed the Articles of Organization:
Date
366 Rev. 03/03
(see instructions on back)