Revised 09/09
Update of Corporate Ofcers & LLC Members
South Dakota Department of Revenue
445 E. Capitol Ave | Pierre, SD 57501-3185 | 1-800-TAX-9188
Name of corporation / LLC:
Federal employers ID number:
South Dakota Department of Revenue Tax License Number:
Address:
Mailing Address:
Phone number: Fax:
Corporate Ofcers & LLC Members
Previous Ofcer / Member Current Ofcer / Member
President: Name:
Name: Address:
Address:
Phone No:
Phone No.: SSN:
SSN: Date effective:
Signature:
Vice-President: Name:
Name: Address:
Address:
Phone No:
Phone No.: SSN:
SSN: Date effective:
Signature:
Secretary: Name:
Name: Address:
Address:
Phone No:
Phone No.: SSN:
SSN: Date effective:
Signature:
Treasurer: Name:
Name: Address:
Address:
Phone No:
Phone No.: SSN:
SSN: Date effective:
Signature:
Mail to: South Dakota Department of Revenue
445 E. Capitol Ave
Pierre, South Dakota 57501
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Pierre, SD 57501