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Page 1 of 2
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.
The jurisdiction under whose law it is formed
South
Dakota
3.
The add
ress 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
individual) or B) a commercial registered agent. Complete only one below, either (a) or (b).
(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) Wh
en listing a Commercial Registered Agent, please state their CRA#. This number can be obtained from the
Commercial Registered Agent.
Commercial Registered Agent Name CRA#
ANNUAL REPORT
DOMESTIC LIMITED LIABILITY COMPANY
SDCL 47-34A-211; 59-11-24, 24.1
FILING FEE: $65
Additional Fee for Delinquent Reports: $50
Page 2 of 2
Annualreportdomesticllc Feb 2018
5. If the LLC is manager-managed, list the names and addresses of its manager(s). SDCL 59-11-24. If the LLC is member-
managed, this section may be left blank.
Manager/Governor Actual Street Address City State ZIP+4
Manager/Governor Actual Street Address City State ZIP+4
Manager/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 perso
n may execute this report knowing it is false in any material respect. Any violation may be subject to a criminal
penalty (SDCL 22-39-36).
Dated
Signature of an authorized person
Email
(Optional) Printed Name
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Completed 4 July 2020

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