South Dakota Perpetual Care Cemetery
Licensed Banking Institution Report
Contact Information
Name of Cemetery
Physical Location of Cemetery
City State Zip
Mailing Address
Mailing City Mailing State Mailing Zip
Person responsible for bookkeeping and records
Email Phone Fax
Owner Corporation ID (Ex: NS2345678)
Entity Type (select one)
Corporation Non-Profit
Licensed Banking Institution Information
Name of Licensed Banking Institution
Address
City State Zip
Principal Account Number
Earnings Account Number
Signature
(I certify that this report is true and correct to the best of my knowledge.)
Date
Secretary of State Jason M. Gant
State Capitol
500 East Capitol Avenue
Pierre SD 57501-5070
Phone: 605-773-3537
Email: sdsos@state.sd.us
Website: www.sdos.gov