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Secretary of State Office
500 E Capitol Ave
Pierre, SD 57501
(605)773-4845
corpinfo@state.sd.us
Enter Filing Year
1. Business ID and Name:
Business ID
Business Name
2.
T
he jurisdiction under whose law it is formed
South
Dakota
3.
T
he 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. T
he South Dakota Registered Agent’s name
South Dakota law permits the registered agent to be either: A) noncommercial registered agent (this may be an
individual), 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 Agent’s 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 the
C
ommercial Registered Agent.
Commercial Registered Agent Name CRA#
(c) Title of the office or other position with the business
Business Office’s 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 BUSINESS CORPORATION
SDCL 59-11-24, 24.1
FILING
FEE: $65
Additional Fee for Delinquent Reports: $50
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Annualreportdomestic Feb 2018
5. 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
6. B
eneficial Interest (optional) - A beneficial owner is a person who has or in some manner controls an equity security.
Please consult an attorney for legal advice if you have any questions concerning this entry. Any question under this
heading is considered a request for legal advice and the Secretary of State’s office is, by statute, not permitted, t
o
pr
ovide legal advice.
Owner Description of Ownership Percentage/Value
Owner Description of Ownership Percentage/Value
N
o 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
click to sign
signature
click to edit