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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:
Enter Business ID
Enter Business Name
2. The jurisdiction under whose law it is formed South Dakota
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 Agent’s name
South Dakota law permits the registered agent to be either: A) noncommercial registered agent (this may be an
in
dividual), 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 t
he
Commercial 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 COOPERATIVE
SDCL 47-20-7, 59-11-24
FILING FEE: $65
Additional Fee for Delinquent Reports: $50
Page 2 of 2
annualreportdomesticcoop
Feb 2018
5. The names and 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).
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Completed 4 July 2020

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