Form Cl-4 - Annual Report Of Electric Cooperative Corporation Property And Grodd Receipts Page 2
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3CL-4
PART III
ANNUAL REPORT TO BE COMPLETED BY ALL ELECTRIC COOPERATIVES
1. Name
2. Organized under the laws of the State of
3. Location of the Registered Office of the Cooperative in the State of South Carolina is
In the City of
Registered Agent at such address is
4. Location of principal office (street address)
5. The total number of authorized shares of capital stock, itemized by class and series, if any, within each class is as follows:
NUMBER OF SHARES
CLASS
SERIES
6. The total number of issued and outstanding shares of capital stock itemized by class and series, if any, within each class is as follows:
NUMBER OF SHARES
CLASS
SERIES
7. The names and business addresses of the directors (or individuals functioning as directors) and principal officers in the Cooperative are:
(If additional space is necessary, attach separate schedule).
NAME
TITLE
BUSINESS ADDRESS
8. Date Organized
Date commenced business in the State of South Carolina was
9. Date of this report
FEIN
10. If Foreign Entity, the date qualified to do business in the State of South Carolina is
11. Was the name of the Cooperative changed during the year?
Give old name
12. The Cooperative's books are in the care of
Located at (street address)
I, the undersigned, a principal officer of the electric cooperative for which this return is made declare that this return, including
Please
accompanying Annual Report, statements and schedules, has been examined by me and is to the best of my knowledge and belief,
Sign
a true and complete return.
Here
Signature of officer
Officer's title
Officer's printed name
Date
Telephone Number
Preparer's Printed Name
I authorize the Director of the Department of Revenue or delegate to
discuss this return, attachments and related tax matters with the preparer.
Yes
No
Date
Preparer's Telephone Number
Preparer's
Check if
Paid
signature
self-employed
Preparer's
Firm's name (or
PTIN or FEIN
Use Only
yours if self-employed)
ZIP Code
and address
If this is an electric cooperative's final return, signing here authorizes the Department of Revenue to disclose that information with the Secretary of
State. You must close with the Secretary of State as well as the Department of Revenue and complete I-349.
Taxpayer's Signature
Date
ATTACH COMPLETE COPY OF FEDERAL RETURN
Make check payable to: SC Department of Revenue. Include Business Name, FEIN and SC File Number.
Go to and look for the DOR ePay logo for other payment options.
31352024
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