File Number BRA-25 (10/08) ANNUAL REPORT FOR FOREIGN AND DOMESTIC LIMITED LIABILITY COMPANIES (LLC) GOVERNMENT OF THE DISTRICT OF COLUMBIA DUE JUNE 16th Filing Fee$ _______________ Penalty _______________ Total $ RETAIN A COPY FOR YOUR RECORDS SEE REVERSE SIDE FOR FILING FEES, PENALTIES, ETC. MAKE CHECK PAYABLE TO D.C. TREASURER MAIL REPORT TO : DEPT. OF CONSUMER AND REGULATORY AFFAIRS BUSINESS REGULATION ADMINISTRATION, CORPORATIONS DIVISION P.O. BOX 92300, WASHINGTON, D.C. 20090 _______________ Interest Indicate if LLC is (Check 1) Domestic _______________ Foreign 3. Name of registered agent and address of registered office in the District of Columbia (Do not make change of agent or address on this form) 2. Organized under the laws of (insert District of Columbia, State or Country) ATTACH PAYMENT HERE 1. Name of Limited Liability Company 4. Address, including street and number, if any, of principal executive offices (may be located in or outside of the District of Columbia). 5. The name(s) and address(es), including street and number of the manager(s) NAME ADDRESS 6. Name and address of authorized person executing this report. NAME ADDRESS By _____________________________________________(signature) Authorized Person FILING FEE: Each Domestic and Foreign LLC pays a filing fee of $50.00 PENALTY: Each Domestic and Foreign LLC pays a penalty of $25.00 if not filed by June 16. FILED A fee of $50.00 will be charged for dishonored checks By American LegalNet, Inc. www.FormsWorkFlow.com