ANNUAL REPORT / ANNUAL FEES (PLEASE TYPE OR PRINT CLEARLY IN INK) The following is a list of Cooperatives and Associations which are required under Arkansas law to file an annual report and if applicable, pay a fee to the office of the Secretary of State. Please complete the information and return the report and the required fee for your organization. Name of Cooperative or Association: __________________________________________________________________ Address: ________________________________________________________________________________________ ________________________________________________________________________________________________ Contact Person: _____________________________________ Phone Number: ________________________________ E-mail Address: ___________________________________________________________________________________ PLEASE CHECK ONE OF THE FOLLOWING □ □ □ Agricultural Cooperative Association A.C.A. Section 2-2-123 ANNUAL FEE - $10.00 Electrical Cooperatives – DUE BEFORE July 1 OF EACH YEAR A.C.A. Section 23-18-329 ANNUAL FEE - $10.00 per 100 members or fractional thereof Number of members: Fee: Marketing Association (PLEASE SUBMIT THESE REQUIREMENTS BY ATTACHMENT.) A.C.A. Section 2-2-422 – Annual Report – NO FEE Principal place of business: Provide a general statement of the business operations during the fiscal year showing: a. The amount of capital stock paid up and the number of stockholders of the stock association; or the number of members and amount of membership fees received if a non-stock association; b. The total expense of operations; c. The amount of indebtedness or liability; and d. A balance sheet □ Cooperation Association A.C.A. Section 4-30-114 – Annual Report – NO FEE Name of Stockholders and amount of stock owned by each: Name Stock Owned ___________________________________________________ ____________________________________________ ___________________________________________________ ____________________________________________ ___________________________________________________ ____________________________________________ ___________________________________________________ ____________________________________________ ___________________________________________________ ____________________________________________ ___________________________________________________ ____________________________________________ Attach separate list if necessary □ Other Association Type and Authority: ___________________________________________________________ ________________________________________________________________________________________________ CRD-01 Rev. 09/07 American LegalNet, Inc. www.FormsWorkflow.com