201 ANNUAL REPORT FOR NONPROFIT CORPORATION Report Due August 1st Pursuant to A 247 4-33-131 File Online Today at www.sos.arkansas.gov 1 . N a me of the Nonprofit Corporation : 2. Jurisdiction of incorporation ( S tate or foreign country ) under whose laws the corporation was incorporated : 3. Name of Registered Agent for Service of P rocess: Address for Registered Agent, MUST be a physical address in the State of Arkansas: City: State: Zip: E - mail (optional): Phone (optional): 4 . Address for Corporation222s Principal O ffice: City: State: Zip: E - mail (optional): Phone (optional): 5. Names of Principal Officers: Address es of Principal Officers: 6.Names of Directors(minimum of 3 persons): Addresses of Directors: NOTE : Include any additional officers or directors on page 2, if needed. 7. Annual Report Contact Name and Address (if different than above): Address: City: State: Zip: 8. Is this entity registered with the IRS as an exempt organization? (optional) If yes, what type of exemption status is held? (optional) I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days. Executed this day of , 20 . Signature and Title of Authorized Director or Officer Printed Name and Title of Authorized Director or Officer 001027021n024030n030007r013027r031n027035025016007031n031r$'#$t 003n026020031025022037004020031031022r006025013021 American LegalNet, Inc. www.FormsWorkFlow.com Please list any additional Principal Officers or Board of Directors below: 5. Names of Principal Officers: Address es of Principal Officers: 6.Names of Directors: Addresses of Directors: 001027021n024030n030007r013027r031n027035025016007031n031r$'#$t 003n026020031025022037004020031031022r006025013021 American LegalNet, Inc. www.FormsWorkFlow.com