MINNESOTA SECRETARY OF STATE DOMESTIC CORPORATION ANNUAL RENEWAL Minnesota Statutes Chapter 302A/319B Must be filed by December 31 READ THE INSTRUCTIONS BEFORE COMPLETING THIS FORM ___________________________________________________________________________________________ ________________________________________________________ 1. File Number: 2. Governed Under the Laws of the State of: MINNESOTA 3. Corporate Name: (Required) 4. Registered Office Address: (Required) Street: _____________________________________________________________________________________ (A PO Box by itself is not acceptable) City: ________________________________________ State: ____________ Zip: _____________________ Registered Agent: (if applicable) _______________________________________________________________ 5. Principal Executive Office Address: (Required) Street:______________________________________________________________________________________ (A PO Box by itself is not acceptable) City: _______________________________________ State: ____________ Zip: ________________________ 6. Name and Business Address of C.E.O.: (Required) CEO Name: ________________________________________________________________________________ Street:_____________________________________________________________________________________ City: _______________________________________ State: ____________ Zip: _______________________ 7. Does this corporation own, lease, or have any financial interest in agricultural land or land capable of being farmed? Yes _____ No_____ 8. Name, daytime telephone number and e-mail address of contact person: Name: ____________________________________Phone:(_______)_____________________ Ext. __________ E-Mail Address: _____________________________________________________________________________ NOTICE: Failure to file this form by December 31 of this year will result in the dissolution of this corporation without further notice from the Secretary of State, pursuant to Minnesota Statutes 302A 821. American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR COMPLETING THIS FORM All business corporations governed under Chapter 302A/319B are required to file an annual renewal once every calendar year. Items 3 and 4 are filed within the articles of incorporation; if there is a change to this information you must amend your articles of incorporation. The amendment form along with the $35.00 filing fee must be submitted at the same time as your annual renewal. You cannot use the annual renewal form to make changes to the articles of incorporation. Items 5 through 8 can be changed once a year by filing the annual renewal form with our office. PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK. 1. File Number: Provide the file number issued by the Minnesota Secretay of State 2. Governed under the Laws of the State of: This form is to be filed only if the state of incorporation is Minnesota. 3. Corporate Name: (Required) List the corporate name on file with the Secretary of State's office. If changes to the corporate name are necessary an amendment form and $35 fee must be included with the annual renewal. 4. Registered Agent, if any and Registered Office Address: (Required) If changes to the registered agent name or address are necessary an amendment form and $35 fee must be included with the annual renewal. 5. Principal Executive Office Address: (Required) A full street address or rural route and rural route box number is required for filing the annual renewal. A post office box alone is not acceptable. 6. Name and Business Address of Chief Executive Officer: (Required) Fill in the name and complete business address of the Chief Executive Officer or other person who carries out the functions as C.E.O. of the corporation. 7. Does the corporation own, lease, or have any financial interest in agricultural land or land capable of being farmed? This question is optional. Check Yes or No. 8. Name, daytime telephone number and e-mail address of contact person for the corporation: Please list a name, daytime telephone number and an e-mail address of a person who can be contacted about this form. A business corporation that has been statutorily dissolved by our office may retroactively reinstate its existence by filing the current year's renewal and paying a $25.00 fee. For your convenience the Office of the Secretary of State does provide standard forms for most filings or for an additional $10.00 fee you may use express services to file online. Go to our web site at www.sos.state.mn.us or contact us between 9:00 am to 4:00 pm, Monday through Friday (excluding holidays), at (651) 296-2803 or toll free 1-877-551-6SOS (6767). If this form is being mailed with an amendment form, please submit all items together and mail to the address below: FILE IN-PERSON OR MAIL TO: Minnesota Secretary of State - Renewals Retirement Systems of Minnesota Building 60 Empire Drive, Suite 100 St Paul, MN 55103 (Staffed 8:00 - 4:00, Monday - Friday, excluding holidays) All of the information on this form is public. Minnesota law requires certain information to be provided for this type of filing. If that information is not included, your document may be returned unfiled. This document can be made available in alternative formats, such as large print, Braille or audio tape, by calling (651)296-2803/voice. For a TTY/TTD (deaf and hard of hearing) communication, contact the Minnesota Relay Service at 1-800-627-3529 and ask them to place a call to (651)296-2803. The Secretary of State's Office does not discriminate on the basis of race, creed, color, sex, sexual orientation, national origin, age, marital status, disability, religion, reliance on public assistance or political opinions or affiliations in employment or the provision of service. Bus8DCrenewalRev09/06/11 American LegalNet, Inc. www.FormsWorkFlow.com