Form Sc 1120u - Public Utility Tax Return (Page 3 of 9) in pdf

Form Sc 1120u - Public Utility Tax Return Page 3

Page 3

SC1120U

SCHEDULE D

ANNUAL REPORT TO BE COMPLETED BY ALL CORPORATIONS

1. Name

Incorporated under the laws of the State of

3. Location of the Registered Office of the Corporation in the State of South Carolina is

In the City of

Registered Agent at such address is

4. Location of principal office (street address)

Nature of principal business in SC

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 Corporation are:

(If additional space is necessary, attach separate schedule).

NAME

TITLE

BUSINESS ADDRESS

8. Date Incorporated

Date commenced business in the State of South Carolina was

9. Date of this report

FEIN

10. If Foreign Corporation, the date qualified to do business in the State of South Carolina is

11. Was the name of the Corporation changed during the year?

Give old name

12. The Corporation's books are in the care of

Located at (street address)

13. If filing consolidated, complete and attach Schedule J for each Corporation included in the consolidation.

30973028

Form Sc 1120u - Public Utility Tax Return Page 3