81 River Street, Drawer 09 Montpelier, VT 05609 State of Vermont Tel: (802) 828-2386 Fax: (802) 828-2853 Office of the Secretary of State Corporations Division NonProfit Biennial Report Deborah L. Markowitz Secretary of State Betty Poulin Director, Corporations Division File Number: Mail completed form, with the appropriate fee, to the Secretary of State, 81 River Street, Montpelier, VT 05609-1104. Information fields preceded by an asterisk (*) are optional. To receive an approved copy for your records enclose a duplicate copy and a stamped self-addressed return envelope. This report is required in accordance with 11B V.S.A. § 16.22. c d e f g Check here if information has NOT changed. First time filers may not check this box. CORPORATE NAME: REGISTERED AGENT: REGISTERED OFFICE: , NAMES AND BUSINESS ADDRESSES OF CURRENT DIRECTORS AND OFFICERS: The same individual may hold more than one office in a corporation except the president and secretary may not be the same person. You must list the name of the president and the secretary. President: VPresident: Secretary: Treasurer: Director1: Director2: Director3: PRINCIPAL OFFICE ADDRESS: , *PURPOSE OF ORGANIZATION: Choose one *DO YOU HAVE TAX-EXEMPT STATUS WITH THE IRS? n Yes n No j k l m j k l m * PAID STAFF THIS YEAR: None *BUDGET THIS YEAR: $0-24,999 *VOLUNTEER STAFF THIS YEAR: None FEE: is $15.00 except that a corporation which certifies that it did not compensate its officers, directors or employees during the prior calendar year shall be exempt from this fee. Check one box and sign below. j k l m n I certify that no compensation was paid to any officer, director or employee during the prior year. i j k l m n The above statement doesn't apply. The required filing fee of 15.00 is enclosed. I hereby attest that the information is correct and current to the best of my knowledge. American LegalNet, Inc. www.USCourtForms.com SIGNATURE: Signature ____________________ Title ______________ Date ________ American LegalNet, Inc. www.USCourtForms.com