Form Cl-1 - Initial Annual Report Of Corporations
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1
2STATE OF SOUTH CAROLINA
STATE OF SOUTH CAROLINA
1350
1350
DEPARTMENT OF REVENUE
DEPARTMENT OF REVENUE
CL-1
INITIAL ANNUAL
(Rev. 9/7/10)
3134
REPORT OF CORPORATIONS
Office Use Only
File Number
ENDING PERIOD
SID Number
Month
Year
For Secretary of State Use Only
Date "Application for Charter" filed with Secretary of State
Date of "Request for authority to do business in this state" (Foreign Corp.)
FEIN
Business Code
(Office Use Only)
Check if subchapter S election
NAME OF CORPORATION
Telephone #
PHYSICAL ADDRESS OF HEADQUARTERS
MAILING ADDRESS FOR TAX CORRESPONDENCE
(NUMBER AND STREET)
CITY AND STATE
ZIP
COUNTY
CITY AND STATE
ZIP
1. State of incorporation:
2. Indicate month corporation closes its books:
3. Nature of principal business in SC:
4. Location of registered office of the corporation in the state of SC is in the city of
Registered agent at such address is
5. Location of principal office in SC (street, city, zip and county):
6. Date business commenced in SC:
Effective Date of Incorporation:
7. If a professional corporation, are all shareholders, one-half of the directors (or individuals functioning as directors) and all
officers (other than the secretary and treasurer) qualified to practice the professional services engaged in by the
corporation?
8. The names and business addresses of the directors (or individuals functioning as directors) and principal officers in the
corporation are:
Name/Title
Business Address and Office
9.
The total number of authorized shares of capital stock itemized by class and series, if any, within each class
as follows:
Number of Shares
Class
Series
10.
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
1. Fee due with this report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.
25 00
2. Interest due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.
3. Penalty due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.
4. Total - Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.
See instructions for payment and mailing.
AFFIDAVIT
I, the undersigned incorporator or principal officer of the corporation for which this return is made, declare that this return, including
accompanying statements and schedules, has been examined by me and is to the best of my knowledge and belief a true and
complete return made in good faith.
THIS RETURN PREPARED BY
SIGNATURE OF INCORPORATOR OR OFFICER AUTHORIZED TO SIGN
DATE
TITLE
31341027
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