DOMESTIC LLC FILING FEE: $ 15.00 H 335 Merchant Street Mailing Address: Annual Filing, P.O. Box 40, Honolulu, HI. 96810 DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS BUSINESS REGISTRATION DIVISION STATE OF HAWAII DOMESTIC LIMITED LIABILITY COMPANY ANNUAL REPORT AS OF COMPANY NAME AND MAILING ADDRESS: (If the above mailing address has changed, line out and print change on the right.) 1. Principal Office Address is: (If address of the principal office has changed, line out and print change on the right.) 2. NATURE OF BUSINESS: (Optional) (To correct, line out and print corrections below. If inactive during the period, state INACTIVE) 3. Organized under the laws of: Hawaii 4. The name of the registered agent and the registered agent's street address of the place of business in Hawaii of the person to which service of process and other notice and documents being served on or sent to the entity represented by it may be delivered to. (If any change, line out and print change on the right. See reverse side for instructions.). 5. The company is: If company is manager-managed, state the total number of members here: 6. Managers or members are: (If any change, line out and print correction on the right. See reverse for instructions.) TITLE NAME ADDRESS (INCLUDE CITY, STATE & ZIP CODE) I certify under the penalties of Section 428-1302, Hawaii Revised Statutes, that I have read the above, the information is true and correct, and I am authorized to sign this report. DATE: FILE NO. Rev. 10/2013 Signature of an authorized manager of a manager-managed company, member of a ember-managed company, fiduciary (if the company is in the hands of a receiver, trustee, or other court-appointed fiduciary), or attorney-in-fact File this Original (SEE REVERSE SIDE FOR INSTRUCTIONS) American LegalNet, Inc. www.FormsWorkFlow.com DECLARATION Print Name L17 L22 BSA INSTRUCTIONS If any questions, call: (808) 586-2727) The annual report must be typewritten or printed in Black Ink, and must be legible. The report must be signed in black ink and certified by a manager of a manager-managed company or by a member of a member-managed company, attorney-in-fact of the signer, receiver, trustee or other court appointed fiduciary. If signed by an attorney-in-fact, indicate the name of the person for whom you are the attorney-in-fact. The filing fee of $ 15.00 must be submitted with the report. Make check payable to the DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS. Filing fee is not refundable. Your cancelled check is your receipt. There is a $ 25.00 charge for all dishonored checks. Failure to file an annual report for any year within the prescribed time will subject the limited liability company to a maximum penalty of $100.00 for every thirty days the delinquency continues. The Director of Commerce and Consumer Affairs may administratively terminate the limited liability company for failure to file an annual report for a period of two years. 1. State the address of the limited liability company's principal office. 2. (Optional) State a brief description of the nature of business. If inactive for the period, state INACTIVE. (Annual report must be filed for the period, even though the company was inactive.) 3. List the State or Country where the limited liability company was organized. 4. State the name of the registered agent and the complete street address (including number, street, city, state, and zip code) in Hawaii. The agent must be an individual resident of Hawaii, a domestic entity, or a foreign entity authorized to transact business or conduct affairs in the State of Hawaii. A domestic limited liability company cannot be its own agent. (The Director of Commerce and Consumer Affairs may administratively terminate the company for failure to maintain a registered agent and registered office.) 5. State whether the limited liability company is manager-managed or member-managed. If the company is manager-managed, state the total number of members. 6. State the names and business addresses of all the managers if the company is manager-managed, or state the names and business addresses of all the members if the company is member-managed. Due Date: Effective January 1, 2003, for a domestic or foreign limited liability company whose date of organization or registration in this State falls between: (1) January 1 and March 31, an annual report shall be filed on or before March 31 of each year and shall reflect the state of the company's affairs as of January 1 of the year when filed; (2) April 1 and June 30, an annual report shall be filed on or before June 30 of each year and shall reflect the state of the company's affairs as of April 1 of the year when filed; (3) July 1 and September 30, an annual report shall be filed on or before September 30 of each year and shall reflect the state of the company's affairs as of July 1 of the year when filed; and (4) October 1 and December 31, an annual report shall be filed on or before December 31 of each year and shall reflect the state of the company's affairs as of October 1 of the year when filed. New companies An annual report is not required to be filed in the year the domestic limited liability company was organized. This material can be made available for individuals with special needs. Please call the Division Secretary, Business Registration Division, DCCA, at 586-2744, to submit your request. All Business Registration filings are open to public inspection. (Section 92F-11, HRS) Mail the completed report with fee to: Annual filing - BREG P.O. Box 40 Honolulu, HI 96810 DID YOU REMEMBER TO SIGN YOUR REPORT AND CHECK? Renew online at www.ehawaii.gov/annuals American LegalNet, Inc. www.FormsWorkFlow.com