For Office Use Only Wyoming Secretary of State 2020 Carey Avenue, Suite 700 Cheyenne, WY 82002-0020 Ph. 307.777.7311 Fax 307.777.5339 Email: SOSRequest@wyo.gov AR Request - Revised May 2016 Request for Annual Report Worksheet(s) Name of Entity: Name of person requesting worksheet(s): Title: I am requesting the annual report worksheet(s) for the year(s). Signature: Date: Print Name: Send copies to: Mailing Address Email Address (Please choose one) Mailing/Email Address: State of County of The foregoing instrument was acknowledged before me by . Signatory222s Printed Name Notary Public222s Signature Notary Date (mm/dd/yyyy) Notary222s Commission Expiration Notarial Seal: Form may be submitted by: Fax: 307.777.5339 Email: SOSRequest@wyo.gov Mail-in: Refer to address at top of this form American LegalNet, Inc. www.FormsWorkFlow.com