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Annual Report Form. This is a South Dakota form and can be use in Corporation Secretary Of State.
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Tags: Annual Report, South Dakota Secretary Of State, Corporation
Secretary of State Office
500 E Capitol Ave
Pierre, SD 57501
(605)773-4845
ANNUAL REPORT
FILE DATE
DOMESTIC L.L.C.
____________________
RECEIPT NO ___________________
Please Type or Print Clearly in Ink
FILING FEE: $50 Make check payable to SECRETARY OF STATE
1. L.L.C. ID and Name:
Telephone # ____________________
FAX #
_______________________
FILING DATE: Due during the month
the Certificate of Organization was
issued, and delinquent after the last
day of the following month.
South Dakota
2. The jurisdiction under whose law it is formed __________________________________________________________
3. The address of the principal executive office in or out of the State of South Dakota.
______________________________________________________________________________________________
Street Address
City
State
ZIP+4
______________________________________________________________________________________________
Mailing Address (Optional)
City
State
ZIP+4
4. 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
5. The names and business addresses of its managers. If the L.L.C. is member-managed the names and addresses
of the members need not be set forth.
______________________________________________________________________________________________
Manager
Street Address
City
State
ZIP+4
______________________________________________________________________________________________
Manager
Street Address
City
State
ZIP+4
______________________________________________________________________________________________
Manager
Street Address
City
State
ZIP+4
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)
annualreportdomesticllc July 2010
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