Secretary of State Office 500 E Capitol Ave Pierre, SD 57501 (605)773-4845 ANNUAL FARM REPORT Corporation FILE DATE ____________________ RECEIPT NO ___________________ Please Type or Print Clearly in Ink No Filing Fee 1. Corporate ID, Name and Address: Telephone # ____________________ FAX # _______________________ FILING DATE: To be filed with the Annual Report. 2. The name of the South Dakota Registered Agent _______________________________________________________ ______________________________________________________________________________________________ Street Address (Required to be a South Dakota Address) City State ZIP+4 ______________________________________________________________________________________________ Mailing Address (Optional – Required to be a South Dakota Address) City State ZIP+4 3. List only the changes since the last report of the acreage and location by section, township and county of each lot or parcel of land in this state owned or leased by the corporation. _______________________________________________________________________________________________ County Section Township Acres _______________________________________________________________________________________________ County Section Township Acres _______________________________________________________________________________________________ County Section Township Acres 4. Please complete the appropriate section: Family Farm Corporation Authorized Farm Corporation The NUMBER OF SHARES owned by person(s) who are members of a family as defined in SDCL 47-9A-2, one of such shareholders being a family member who is residing on the farm or actively operating the farm, or who has resided on or has actively operated the farm. (See SDCL 47-9A-14) ________________ The PERCENTAGE of gross receipts of the corporation derived from rent, royalties, dividends, interest and annuities. ______________% 5. List any changes to shareholder name, address and number of shares owned. ________________________________________________________________________________________________ Name Address City State Zip Shares ________________________________________________________________________________________________ Name Address City State Zip Shares ________________________________________________________________________________________________ Name Address City State Zip Shares No person may execute this report knowing it is false in any material respect. Any violation is subject to a civil penalty. Dated ____________________________ ______________________________________________ (Signature of an Authorized Person) ______________________________________________ (Printed Name) corporationfarmreport July 2010 American LegalNet, Inc. www.FormsWorkFlow.com