ANNUAL FARM REPORT Secretary of State Office 500 E Capitol Ave Pierre, SD 57501 (605)773-4845 Limited Liability Company FILE DATE ____________________ RECEIPT NO ___________________ Please Type or Print Clearly in Ink No Filing Fee 1. L.L.C. 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 Limited Liability Company. _______________________________________________________________________________________________ County Section Township Acres _______________________________________________________________________________________________ County Section Township Acres _______________________________________________________________________________________________ County Section Township Acres 4. Please complete the appropriate section: Family Farm Corporation The NUMBER OF MEMBERSHIP INTERESTS 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) Authorized Farm Corporation The PERCENTAGE of gross receipts of the company derived from rent, royalties, dividends, interest and annuities. ________________ ______________% 5. List changes only of names, address and number of membership interests owned by shareholders. ________________________________________________________________________________________________ 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) llcfarmreport July 2010 American LegalNet, Inc. www.FormsWorkFlow.com