Annual Report (Non Profit Corp)

Page 1 of 2 Enter Filing Year Secretary of State Office 500 E Capitol Ave Pierre, SD 57501 (605)773-4845 corpinfo@state.sd.us 1.Business ID and Name: Business ID Business Name 2.The jurisdiction under whose law it is formed South Dakota 3.The address of the principal executive office (business address). Actual Street Address City State ZIP+4 Mailing Address, if Different from Street Address City State ZIP+4 Email Address (Optional) 4.The South Dakota Registered Agent222s name South Dakota law permits the registered agent to be either: A) a noncommercial registered agent (this may be anindividual), B) a commercial registered agent, or C) an office holder. Complete only one below, either (a) or (b) or (c). (a)The South Dakota Noncommercial Registered Agent222s name Actual Street Address in this State City State ZIP+4 Mailing Address in this State, if Different from Street Address City State ZIP+4 Email Address (Optional) (b)When listing a Commercial Registered Agent, please state their CRA#. This number can be obtained from theCommercial Registered Agent. Commercial Registered Agent Name CRA# (c)Title of the office or other position with the business Business Office222s Actual Street Address in this State City State ZIP+4 Mailing Address in this State, if Different from Street Address City State ZIP+4 Email Address (Optional) ANNUAL REPORT DOMESTIC NONPROFIT CORPORATION SDCL 47-24-6, 59-11-24 FILING FEE: $ 10 Make check p a y ab l e t o SECRE T A R Y OF S T A TE American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 annualreportdomesticnonprofit 5.The names and addresses of its principal officers and directors (governors). South Dakota Law requires at least threedirectors. Principal Officer/Director/Governor Actual Street Address City State ZIP+4 Principal Officer/Director/Governor Actual Street Address City State ZIP+4 Principal Officer/Director/Governor Actual Street Address City State ZIP+4 Principal Officer/Director/Governor Actual Street Address City State ZIP+4 6.Beneficial Interest (optional) Owner Description of Ownership Percentage/Value Owner Description of Ownership Percentage/Value No person may execute this report knowing it is false in any material respect. Any violation may be subject to a civil and/or criminal penalty (SDCL 22-39-36). Dated Signature of an authorized person Email (Optional) Printed Name American LegalNet, Inc. www.FormsWorkFlow.com