Annual Report Foreign 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 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 FOREIGN NONPROFIT CORPORATIONSDCL 47-27-18, 59-11-24 to 26 FILING FEE:$10 Make check payable to SECRETARY OF STATE American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 annualreportforeignnonprofit 5.The names and addresses of its principal officers and directors (governors). 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