b. Is(Are) the owner(s) of the organization a United States Armed Forces veteran(s)?
14. Veteran Employees and Veteran Owner Information:
a. Does your organization employ individuals who are United States Armed Forces veterans?
* If "Yes," enter the total number of veterans it employs.
Annual Report for fiscal year (enter the NEXT calendar year) for Corporations,
Limited Partnerships, Limited Liability Partnerships, Voluntary Associations, and/or
Business Trusts (per WV Code 59-1-2a)
Rev. 02/16Issued by the Office of the Secretary of State
Important Note: This form is a public document. Please DO NOT provide any personal identifiable information on this form such as social security
numbers, bank account numbers, credit card numbers, or driver's license numbers.
1. Name of the Organization:
2. Incorporation or Qualification Date:
In which state:
County Code*:
*If you do not know the codes, you may leave the above sections blank.
Zip Code:State:City:
Address 1:
County:
Address 2:
4. Principal Office Address:
5. Principal Mailing Address:
Zip Code:State:City:
Address 2:
Address 1:
6. Name and Mailing Address of
person (agent) to whom notice
of legal process may be sent, if
any:
Zip Code:
State:City:
Address 2:
Address 1:
Name:
*If new agent, furnish new agent's signature:
7. Business E-mail Address where business correspondence may be sent:
10. Total number of West Virginia residents:
9. Total number of employees:
8. Website address of the business, if any (ex: yourdomainname.com):
SP
SP
Mailing AddressOrganization Name
15. List names and addresses of the entity's parent company, if any. Also, list each entity's subsidiaries that are licensed to do business in
WV. Please check whether each name is a Parent or a Subsidiary by checking the appropriate box next to the appropriate letter (“P”
for Parent, “S” for Subsidiary) for each line. Attach additional sheet if necessary.
11. Is this a minority owned business?
12. Is this a woman owned business?
13. Do you own or operate more than one
business in West Virginia?
b. Located in how many West Virginia counties?If "Yes"... a. How many businesses?
Yes No Decline to answer
Yes* No Decline to answer
Yes No Decline to answer
* Answer a. and b. below.
Yes No Decline to answer
Yes No Decline to answer
3. Tax ID #:
Business Class Code*:
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