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domesticcooperativeamendedannualreport Nov 2016
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
DOMESTIC COOPERATIVE
SDCL 47-20-7; 59-11-24 through 26
FILING FEE: $25
Make check payable to SECRETARY OF STATE
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Completed 4 July 2020

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