District of Columbia Government Corporations Division Form BRA-28. Version 2, July 2010. Two-Year Report for Domestic & Foreign Non-Profit Corporation Year of Filing: Use this form to file a two-year report for a domestic or foreign non-profit corporation. File Number: Date of Filing: Filing Fee: 1. Entity Name. 2. Organized under the laws of which state or country. 3. If this is a foreign corporation, address of principal office in state or country where it is organized. 4. Name of Registered Agent and address of registered office in DC. 5. Brief statement of business affairs conducted in DC. 6. If this is domestic corporation, address of principal office in DC. 7. List all corporation directors and officers (attach list if needed) TITLE NAME 8. Date Organized FOREIGN NON-PROFIT CORPORATIONS: ANSWER 8-10 9. Term of existence authorized 10. Is corporation in good standing in state / country where it is organized? Yes No 11. Select corporate officer executing this form: President / Vice-President ADDRESS 12. Signature Secretary / Assistant Secretary Treasury / Assistant Treasury If you sign anywhere on the Two-Year 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 § 22-2405. 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 American LegalNet, Inc. www.FormsWorkFlow.com