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MINNESOTA SECRETARY OF STATE
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DOMESTIC AND FOREIGN LIMITED LIABILITY COMPANY
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ANNUAL REGISTRATION
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Minnesota Statutes Chapter 322B
form is completed, be sure to
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Must be filed by December 31
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CURRENT INFORMATION ON FILE:
1. Charter#:
2. This LLC is formed under the laws of:
3. Limited Liability Company Name:
4. Alternate Name, if any (Foreign LLC.s only):
5. Registered Agent/ Registered Office Address:
Agent’s Name (if applicable)
Street:
City:
State:
Zip:
6. Principal Executive Office Address (PO Box not acceptable):
Street:__________________________________________________________________________________________________________________________
City:_____________________________________________________________State:_____________________________________Zip:_________________
7. Name and business address of manager or other person exercising the principal functions of the chief manager of the limited liability company:
Name: _________________________________________________________________________________________________________________________
Street:__________________________________________________________________________________________________________________________
City:_____________________________________________________________State:_____________________________________Zip:_________________
8. Does this limited liability company own, lease, or have any financial interest in agricultural land or land capable of being farmed?
____ Yes ____ No
9. Name and daytime telephone number and/or e-mail address of a contact person:
Name: ___________________________________________________________________________( ______)______________________ Ext. ____________
E-Mail address: __________________________________________________________________________________________________________________
NOTICE: Failure to file this form by December 31 of this year will result in the dissolution of this limited liability company without further notice
from the Secretary of State, pursuant to Minnesota Statutes, section 322B.960.
bus68
Rev. 3-03
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