CHARLES P. WHITE SECRETARY OF STATE BUSINESS SERVICES DIVISION 302 W. Washington Street, Room E018 Indianapolis, Indiana 46204 Telephone: (317) 232-6576 INDIANA BUSINESS ENTITY REPORT State Form 48725 (R4 / 2-11) Approved by State Board of Accounts, 2009 INSTRUCTIONS: 1. All corporations must complete Sections A-H (Section G & H are located on the reverse side of this form). 2. All LLCs must complete Sections A-E and Section H. 3. File report online with a credit card. Refer to www.sos.in.gov. 4. Mail this completed report, along with a check or money order payable to Secretary of State, to Business Services at the above address. SECTION A Current entity name and principal office address (number and street, city, state, and ZIP code) Please make any changes to address here. * * Entity name can not be changed on this report. SECTION B Current filing year Past filing years reported on this form SECTION C Date of incorporation / qualification / formation (month, day, year) State of domicile SECTION D (Please check the appropriate type for your corporate entity.) Business Corporation Professional Corporation Current registered agent and registered address ** ** Nonprofit Corporation Ag Coop Limited Liability Company SECTION E Please make changes to agent and address here. P.O. box is not an acceptable address unless accompanied by a rural route number. SECTION F Current President or highest officer and address (number and street, city, state, and ZIP code) Please make changes to officer and address here. Current Secretary or other officer and address (number and street, city, state, and ZIP code) Please make changes to officer and address here. Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com SECTION G (Please list the name(s) and address(es) of current director(s). If necessary, attach an additional sheet) Name of Director Street Address (number and street) City State ZIP Code SECTION H (This must be signed by a corporate officer, chairman of the board, registered agent, certified public accountant or an attorney employed by the entity or by a member of manager of the LLC.) This document is signed under the penalties of perjury. (Check the fee schedule on the reverse side of this form) Signature Date of signature (month, day, year) FEE SCHEDULE DOMESTIC CORPORATIONS All Indiana / domestic corporations must file a biennial report with the Secretary of State. The fee is $30.00 for a two-year registration. The report is due in the anniversary month of incorporation. Corporations incorporated in an even year must file every even year beginning in 1996. Corporations incorporated in an odd year must file every odd year beginning in 1997. For all domestic corporations any reports due prior to 1996 were filed on an annual basis with a fee of $15.00 per year. FOREIGN CORPORATIONS All foreign (non-Indiana) corporations must file a biennial report with the Secretary of State. The fee is $30.00 for a two-year registration. The report is due in the anniversary month of qualification in Indiana. Corporations qualified in an odd year must file every odd year beginning in 1997. Corporations qualified in an even year must file every even year beginning in 1998. For all foreign corporations any reports due prior to 1997 were filed on an annual basis with a fee of $15.00. LIMITED LIABILITY COMPANIES (domestic and foreign) All limited liability companies (LLC) must file a biennial report with the Secretary of State. The fee is $30.00 for a two-year registration. The report is due in the anniversary month of organization or qualification in Indiana. LLCs organized in an odd year must file every odd year beginning in 1997. LLCs qualified in an even year must file every even year beginning in 1998. For all LLCs any reports due prior to 1997 were filed on an annual basis with a fee of $15.00. NONPROFIT CORPORATIONS All nonprofit corporations (domestic and foreign) must file annual reports in the anniversary month of incorporation. The filing fee is $10.00 per year. LIMITED LIABILITY PARTNERSHIPS AND LIMITED PARTNERSHIPS These entities do not file corporate reports. Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com