Amended Annual Report (Domestic Cooperative)

AMENDED ANNUAL REPORT Enter Filing Year DOMESTIC COOPERATIVE SDCL 47-20-7; 59-11-24 through 26 Secretary of State Office 500 E Capitol Ave Pierre, SD 57501 (605) 773-4845 corpinfo@state.sd.us FILING FEE: $25 Make check payable to SECRETARY OF STATE 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 Mailing Address, if Different from Street Address Email Address (Optional) City City State State ZIP+4 ZIP+4 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 domesticcooperativeamendedannualreport Nov 2016 American LegalNet, Inc. www.FormsWorkFlow.com