Amended Annual Report (Foreign Cooperative)

foreigncooperativeamendedannualreport 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 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 or directors (governors) as per SDCL 47-17-14. President Actual Street Address City State ZIP+4 Vice President Actual Street Address City State ZIP+4 Secretary Actual Street Address City State ZIP+4 Treasurer Actual Street Address City State ZIP+4 Other Principal Officer Actual Street Address City State ZIP+4 Other Principal Officer Actual Street Address City State ZIP+4 Other Principal Officer Actual Street Address City State ZIP+4 No person may execute this report knowing it is false in any material respect. Any violation may be subject to a criminal penalty (SDCL 47-15-51; 22-39-36). Dated Signature of an authorized person Email (Optional) Printed Name Title AMENDED ANNUAL REPORT FOREIGN COOPERATIVE SDCL 47-20-7; 59-11-24 through 26 FILING FEE: $25 Make check payable to SECRETARY OF STATE American LegalNet, Inc. www.FormsWorkFlow.com