Form 366 - Corporation Supplemental Initial Report

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W. Fox McKeithen
Secretary of State
CORPORATION SUPPLEMENTAL INITIAL REPORT
(R.S. 12:25)
Domestic Business Corporation
Return to: Corporation Division
Enclose $20.00 filing fee
P. O. Box 94125
Make Remittance Payable to
Baton Rouge, La 70804-9125
Secretary of State
Phone (504) 925- 4704
Do not send cash
1. The name of this corporation is: ____________________________________________________
2. The names and municipal addresses (not a P.O. Box only) of the first directors are:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Incorporator(s) or shareholder (s) signature(s):
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
366 Rev. 4/97
(See instructions on back)

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