District of Columbia Government Corporations Division Annual Report for Domestic and Foreign Cooperative Association Form BRA-27, Version 2, July 2010. Year of Filing Use this form (BRA-27) to file an Annual Report for a Domestic or Foreign Cooperative Association (Co-op). File Number Date of Filing: Filing Fee: ENTITY TYPE FILING FEE DEADLINE Cooperative Association Refer to Corporate Fee Schedule posted online. FIRST REPORT DUE DATE 60 days after the end of fiscal year 60 days after the end of fiscal year 1. Entity Name 2. Cooperative association's principal address 3. List all corporation directors and officers (attach sheet if needed) TITLE NAME OCCUPATION ADDRESS AUTHORIZED COMPENSATION SUBSCRIBED TERM EXPIRATION DATE PAID-IN 4. Amount and nature of capital ADMITTED DURING YEAR WITHDRAWN DURING YEAR TOTAL NOW 5. Shareholders CAPITAL RETURN RATE PAID PAR VALUE PER SHARE TOTAL PAR VALUE EXPENDITURES LIABILITIES ASSETS 6. Shares 7. Financial (You may attach your audit statement to meet this RECEIPTS requirement.) 8. Operations closing date Mail all forms and required payment to: Department of Consumer and Regulatory Affairs Corporations Division PO Box 92300 Washington, DC 20090 Phone: (202) 442-4400 Please check dcra.dc.gov to view organizations required to register, to search business names, to get step-by-step guidelines to register an organization, to search registered organizations, and to download forms and documents. Just click on Corporate Registrations." American LegalNet, Inc. www.FormsWorkFlow.com NON-SHARE ASSOCIATIONS ONLY: Complete question 9. ADMITTED DURING YEAR WITHDRAWN DURING YEAR TOTAL TOTAL MEMBERSHIP FEES 9. Members President / Vice-President executing this form (required) Signature Secretary / Assistant Secretary executing this form (required) Signature If you sign anywhere on the Annual Report Form, you agree that you understand that anyone who makes a false statement anywhere on it can be punished by criminal penalties of a fine up to $1000, imprisonment up to 180 days, or both, under DCOC § 222405. Mail all forms and required payment to: Department of Consumer and Regulatory Affairs Corporations Division PO Box 92300 Washington, DC 20090 Phone: (202) 442-4400 Please check dcra.dc.gov to view organizations required to register, to search business names, to get step-by-step guidelines to register an organization, to search registered organizations, and to download forms and documents. Just click on Corporate Registrations." American LegalNet, Inc. www.FormsWorkFlow.com