1350 STATE OF SOUTH CAROLINA DEPARTMENT OF REVENUE INITIAL ANNUAL REPORT OF CORPORATIONS Office Use Only (Rev. 5/3/16) 3134 CL-1 File Number ENDING PERIOD Month Year SID Number For Secretary of State Use Only Date " Application for Charter "filed with Secretary of State Date of "Request for authority to do business in this state "(Foreign Corp.) FEIN Business Code (Office Use Only) Check if subchapter Selection NAME OF CORPORATION Email address Telephone # ( ) - PHYSICAL ADDRESS OF HEADQUARTERS (NUMBER AND STREET) MAILING ADDRESS FOR TAX CORRESPONDENCE CITY AND STATE ZIP COUNTY CITY AND STATE ZIP ATTACH REMITTANCE HERE 1. State of incorporation: 2. Indicate month corporation closes its books: 3. Nature of principal business in SC: 4. Location of registered office of the corporation in the state of SC is in the city of Registered agent at such address is 5. Location of principal office in SC (street, city, zip and county): 6. Date business commenced in SC: Effective Date of Incorporation: 7. If a professional corporation, are all shareholders, one-half of the directors (or individuals functioning as directors) and all officers (other than the secretary and treasurer) qualified to practice the professional services engaged in by the corporation? 8. The names and business addresses of the directors (or individuals functioning as directors) and principal officers in the corporation are: Name/Title Business Address and Office 9. The total number of authorized shares of capital stock itemized by class and series, if any, within each class as follows: Number of Shares Class Series 10. The total number of issued and outstanding shares of capital stock itemized by class and series, if any, within each class is as follows: Number of Shares Class 1. 2. 3. 4. Series 1. Fee due with this report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Interest due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Penalty due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. Total - Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . See instructions for payment and mailing. 25 00 00 00 00 AFFIDAVIT I, the undersigned incorporator or principal officer of the corporation for which this return is made, declare that this return, including accompanying statements and schedules, has been examined by me and is to the best of my knowledge and belief a true and complete return made in good faith. THIS RETURN PREPARED BY SIGNATURE OF INCORPORATOR OR OFFICER AUTHORIZED TO SIGN DATE TITLE 31341027 American LegalNet, Inc. www.FormsWorkFlow.com INITIAL ANNUAL REPORT - CL-1 LLCs: Do not complete CL-1 unless you are taxed as a corporation. You must submit a CL-1 and a $25 minimum license fee to the Secretary of State if you are a domestic corporation filing your initial Articles of Incorporation, or a foreign corporation filing an Application for Certificate of Authority to Transact Business in South Carolina. Make all payments payable to the Secretary of State. The Secretary of State cannot process a CL-1 that is not accompanied by Articles of Incorporation or an Application for Certificate of Authority to Transact Business. If you have not already submitted a CL-1 and a $25 minimum license fee to the Secretary of State and are taxed as a corporation and not exempt under SC Code Section 12-20-110, you must submit them to the SC Department of Revenue within 60 days after commencing business in South Carolina or using a portion of your capital in this State. Make the payment payable to the SC Department of Revenue and mail to: SC Department of Revenue, Registration, Columbia, SC 29214-0140. � The minimum fee of twenty-five($25.00) dollars must be paid at the time such report is filed. � Interest is due at the prevailing federal interest rate if this return is not filed within 60 days after commencing business in this state. � Late filing of this return will incur a delinquent penalty of 5% per month not to exceed 25%. � Late payment of the license fee will incur a penalty of 1/2% per month not to exceed 25% . � Address Definitions: The mailing address for tax correspondence will be used if information related to your taxes must be sent to you. LINE INSTRUCTIONS � Federal Employer Identification Number (FEIN or EIN) - If this number has not been obtained, write "applied for" or "to be applied for" in the space provided. The FEIN can be applied for and obtained via the internet, directly from the IRS Website www.irs.gov 24 hours a day, 7 days a week. Business owners or their tax professional representative can enter "EIN" as a keyword to begin the process. While the internet is the preferred method for applying for EIN's, business owners may still obtain EIN's by mailing or faxing Form SS-4, as provided in the form's instructions. Line 2 - If year end date has not been established, write "not known" in the space provided. December will be selected by the SC Department of Revenue. Line 5 - Registered agent must be a resident of South Carolina. Line 5 - If principal office is not in existence at the time of filing, write "not established" in the space provided. Line 6 - If business has not started at the time of filing, state expected date. Also include the effective date of incorporation with the Secretary of State. Line 8 - If all of these positions have not been filled, please indicate and provide names and positions known at the time of filing. Line 10 - If no shares have been issued at the time of filing, please indicate. Special Instructions for Limited Liability Companies, Professional Corporations, and Other Associations Taxed for Income Tax Purposes as Corporations. *Any entity taxed as a corporation and not exempt under SC Code Section 12-20-110 must submit a CL-1 and include a $25 payment. If your organization is a limited liability company or association and is taxed as a corporation: 1. 2. 3. 4. 5. "Corporation" should be interpreted to mean limited liability company or association; "State of incorporation" should be read to mean state of organization; "Shareholders" should be interpreted to mean members; "Director" or "officer" should be interpreted to mean manager or managing member; and "Incorporator" should be read to mean pe