Amended Annual Report (Foreign Business Corp)

foreignamendedannualreport Enter Filing Year Secretary of State Office 500 E Capitol Ave Pierre, SD 57501 (605)773-4845 1.Business ID and Name: Business ID Business Name You may amend any of the information below. If you are not amending a section, please leave that section blank. 2.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) 3.The names and business addresses of its principal officers and directors (governors). If, pursuant to SDCL 47-1A-732(1), the board of directors has been eliminated, list the names of the shareholders. Shareholder/Governor Actual Street Address City State ZIP+4 Shareholder/Governor Actual Street Address City State ZIP+4 Shareholder/Governor Actual Street Address City State ZIP+4 4.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 47-1A-129; 22-39-36). Dated Signature of an authorized person Email (Optional) Printed Name AMENDED ANNUAL REPORT FOREIGN BUSINESS CORPORATION SDCL 59-11-24, 24.1, 47-1A-122 FILING FEE: $25 Make check payable to SECRETARY OF STATE American LegalNet, Inc. www.FormsWorkFlow.com