Form 48725 - Business Entity Report - Indiana Secretary Of State Page 2
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3INDIANA BUSINESS ENTITY REPORT
State Form 48725 (R10 / 11-17)
Approved by State Board of Accounts, 2017
Indiana Code 23-0.5-1.5-8
23-0.5-2-13
23-0.5-9-34
SECTION A
Current entity name and principal office address (number and street, city, state, and ZIP code)
Please make any changes to address here. *
* Entity name cannot be changed on this report.
SECTION B
Current filing year
Past filing years reported on this form
SECTION C
Date of formation / registration (month, day, year)
Jurisdiction of formation
SECTION D
Please check the appropriate type for your corporate entity.
Business Corporation
Professional Corporation
Nonprofit Corporation
Ag Coop
Limited Liability Company (LLC)
Master LLC
Limited Partnership (LP)
Limited Liability Partnership (LLP)
SECTION E
Name of current registered agent
The new registered agent is a: (select one)
Commercial registered agent
Noncommercial registered agent
Current registered address (number and street, city, state, and ZIP code) **
Name of new registered agent
If the registered agent is a noncommercial registered agent, please provide the
address of the registered agent. (number and street, city, state, and ZIP code)
Current e-mail address
E-mail address of the registered agent at which the registered agent will
accept electronic service of process
** P.O. box is not an acceptable address unless accompanied by a rural route number.
SECTION F
Current President or highest officer and address (number and street, city, state, and ZIP code)
Please make changes to officer and address here.
Current Secretary or other officer and address (number and street, city, state, and ZIP code)
Please make changes to officer and address here.
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