Form 802—General Information 
                               (Periodic Report – Nonprofit Corporation) 
 
 The attached form is drafted to meet minimal statutory filing requirements pursuant to the relevant 
 code provisions.   This form and the information provided are not substitutes for the advice and services of an 
 attorney and tax specialist. 
 
                                                Commentary 
 
A nonprofit corporation is required by Section 22.357 of the Texas Business Organizations Code (BOC) to file   a 
periodic report that lists the names and addresses of all directors and officers of the corporation.  The Office   of the 
Secretary of State may require a domestic nonprofit corporation or a foreign nonprofit corporation registered to 
transact business in this state to file a report not more than once every four years.  The failure to file the report 
when due will result, after notice, in the involuntary termination of the domestic corporation or the revocation 
of the registration of the foreign corporation. 
 
    Please note that a document on file with the Secretary of State is a public record that is subject to public 
    access and disclosure.  When providing address information for a director or officer, use a business or 
    post office box address rather than a residence address if privacy concerns are an issue. 
 
                                            Instructions for Form 
 
	  File Number:    It is recommended that the file number assigned by the Secretary of State be provided to 
    facilitate processing of the document. 
 
	  1—Corporation Name:  Provide the legal name of the corporation.  Changes to the name of the 
    corporation require an amendment to the certificate or registration of the corporation.  See Additional 
    Documentation instructions below. 
 
	  2—Jurisdictional Information:      Provide the state or other jurisdiction under the laws of which the 
    corporation is formed. 
 
	  3—Registered Agent:  The registered agent can be either: (option A) a domestic entity or a foreign entity 
    that is registered to do business in Texas; or (option B) an individual resident of the state.  The corporation 
    cannot act as its own registered agent; do not enter the entity name as the name of the registered agent. 
 
    Consent:  A person designated as the registered agent of an entity must have consented, either in a written or 
    electronic form, to serve as the registered agent of the entity.  Although consent is required, a copy of the 
    person’s written or electronic consent need not be submitted with the periodic report.  The liabilities and 
    penalties imposed by Sections 4.007 and 4.008 of the BOC apply with respect to a false statement in a filing 
    instrument that names a person as the registered agent of an entity without that person’s consent.  (BOC § 
    5.207) 
 
	  4—Registered Office Address:  The registered office address must be located at a street address where 
    service of process may be personally served on the entity’s registered agent during normal business hours.  
    Although the registered office is not required to be the entity’s principal place of business, the registered 
    office may not be solely a mailbox service or telephone answering service.  (BOC § 5.201) 

                                                Form 802─  Page 1 of   5 

	  5—Principal Office Address:  Provide the street or mailing address of the principal office of the 
    corporation in the state or country under the laws of which the corporation is incorporated if the corporation 
    is a foreign corporation. 
 
	  6—Directors:  Provide the name and address of each member of the board of directors.  A corporation is 
    generally managed by a board of directors.  However, a corporation that has members may be managed by 
    its members or by a board of directors.  A minimum of three directors is required.  If the space provided is 
    insufficient, include the information as an attachment to this form for item 6. 
 
	  7—Officers:  Provide the name, address, and title of each officer.  The officers of a corporation must 
    include a president and a secretary and may also consist of one or more vice-presidents, a treasurer, and 
    such other officers and assistant officers as may be deemed necessary.  Any one person may serve in more 
    than one office, except the offices of president and secretary.  If the space provided is insufficient, include 
    the information as an attachment to this form for item 7. 
 
	  Execution:  Pursuant to Section 4.001 of the BOC, the periodic report must be signed by a person 
    authorized by the BOC to act on behalf of the entity in regard to the filing instrument.  Generally, a 
    governing person or managerial official of the entity signs a filing instrument.  The periodic report need not 
    be notarized; however, before signing, please read the statements on this form carefully.  The designation or 
    appointment of a person as registered agent by an organizer or managerial official is an affirmation by the 
    organizer or managerial official that the person named in the instrument as registered agent has consented to 
    serve in that capacity.  (BOC § 5.2011) 
 
    A person commits an offense under Section 4.008 of the BOC if the person signs or directs the filing of a 
    filing instrument the person knows is materially false with the intent that the instrument be delivered to the 
    Secretary of State for filing.  The offense is a Class A misdemeanor unless the person’s intent is to harm or 
    defraud another, in which case the offense is a state jail felony. 
 
	  Filing Fees:  The filing fee for a periodic report for a nonprofit corporation is $5.  If the corporation has 
    forfeited its right to conduct affairs for failure to file the periodic report within thirty (30) days of the first 
    notification, the fee is the original $5 plus a late fee of $1 per month or part of a month for one hundred 
    twenty (120) days following the forfeiture, but not less than   $5nor more than $25. 
 
	  Additional Documentation: 
    Name Change (optional):  To change the name of the corporation at the same time of filing the required 
    periodic report, an amendment (Form 424 or 412, as appropriate) and filing fee of$25 and Form 802 and 
    filing fee (as stated in Filing Fees), must be submitted at the same time to the Reports Unit for filing. 

      Reinstatement:  If the report is not filed within the one hundred twenty (120) day period from the date of 
    the second notification, the domestic corporation will be involuntarily terminated or the registration of the 
    foreign corporation will be revoked.  The corporation may be relieved of the involuntary termination or 
    revocation and reinstated by filing the required periodic report (Form 802) and filing fee of $25. 

     Tax Clearance from Comptroller of Public Accounts:  If the corporation is not tax exempt, a tax 
     clearance letter from the Texas Comptroller of Public Accounts stating that the filing entity has satisfied 
     all franchise tax liabilities and may be reinstated is required to be filed with Form 802 and filing fee of 
     $25.  Form 811 is not required when reinstating.  Contact the Comptroller for assistance in complying 
     with franchise tax filing requirements and obtaining the necessary tax clearance letter by email at:  
     tax.help@cpa.state.tx.us  or by calling (800) 252-1381 or (512) 463-4600. 

                                                Form 802─  Page 2 of   5 

   Amendment to Certificate of Formation or Registration:  The name of the corporation must be 
   available at the time of reinstatement.  The administrative rules adopted for determining entity name 
   availability (Texas Administrative Code, Title 1, Part 4, Chapter 79, subchapter C) may be viewed at:  
   http://www.sos.state.tx.us/tac/index.shtml   A preliminary determination on “name availability” may 
   be obtained by calling (512) 463-5555 or e-mail to:  corpinfo@sos.state.tx.us  
   
   At the time of reinstating, if the corporation name is no longer available, or if written consent is required 
   but cannot be obtained for the use of the name, simultaneously submit:  (A) a certificate of amendment 
   to the certificate of formation to change the name of the domestic entity as a condition of reinstatement; 
   or (B) an amended registration to state the assumed name under which the foreign entity shall transact 
   business.  The amendment (Form 424 or 412, as appropriate) and filing fee of$25 and Form 802 and 
   filing fee of$25,and    the tax clearance letter, must be submitted at the same time to the Reports Unit for 
   filing.  Forms 424 and 412 are available at: http://www.sos.state.tx.us/corp/forms_boc.shtml 
 
  Upon completing the reinstatement process of submitting all required forms, paying all applicable filing 
  fees, and meeting all filing requirements, the status of the nonprofit corporation will be changed to in 
  existence. 
 
• Payment Instructions:  Accepted methods of payment are:  (1) a check or money order payable through a 
                                                                                                            
  U.S. bank or financial institution made payable to the Secretary of State; (2) a valid American Express, 
  Discover, MasterCard, or Visa credit card (subject to a statutorily authorized convenience fee of 2.7% of the 
  total fees incurred); (3) a funded LegalEase account; or (4) a prefunded Secretary of State client account. 
  Use Form 815 at:  http://www.sos.state.tx.us/corp/forms_reports.shtml to pay by credit card, LegalEase, 
  or client account.
 
• Delivery Instructions:  Submit the completed form(s), with the filing fees, in duplicate to the Secretary of 
  State. Mail to: Secretary of State, Reports Unit, P.O. Box 12028, Austin, Texas  78711-2028; deliver to: 
  James Earl Rudder Office Building, Reports Unit, 1019 Brazos, Austin, Texas  78701; or fax to:  (512) 
  463-1423 (requires Form 815 for payment).  On filing the document(s), the Secretary of State will return the 
  appropriate evidence of filing to the submitter together with a file-stamped copy of the document, if a 
  duplicate copy was provided as instructed.  If you require additional assistance, you may contact the Reports 
  Unit at: (512) 475-2705.
 
  Revised 08/12 

                                      Form 802─  Page 3 of   5 

 Form 802                                                                            This space reserved for filing office use. 
 (Revised 08/12) 
 Submit in duplicate to: 
 Secretary of State 
 Reports Unit 
 P.O. Box  12028                                                        
                                                                  
 Austin, TX  78711-2028 
 Phone:  (512) 475-2705                     Periodic Report  
 FAX:  (512)  463-1423                                      of a 
 Dial:  7-1-1 for Relay Services 
 Filing Fee:  See Instructions       Nonprofit Corporation 
 
 File Number:                    
 1.  The name of the corporation is: (A name change requires an amendment; see Instructions)  

 2.  It is incorporated under the laws of:  (Set forth state or foreign country)           

 3.  The name of the registered agent is: 
       A.  The registered agent is a corporation (cannot  be entity named above) by the name of: 

 OR 

      B.  The registered agent is an individual resident of the state whose name is: 

 First Name                          MI                           Last Name                                                    Suffix 

 4. The registered office address, which is identical to the business address of the registered agent in Texas, is:  
    (Only use street or building address; see Instructions) 

                                                                                                     TX                              
 Street Address                                                             City                     State                     Zip Code 

 5. If the corporation is a foreign corporation, the address of its principal office in the state or country under 
    the laws of which it is incorporated is: 

 Street or Mailing Address                                        City                     State Zip Code                      Country 

 6.  The names and addresses of all directors of the corporation are:  (A minimum of three directors is required.) 
                           (If additional space is needed, include the information as an attachment to this form for item 6.)  

 First Name                                  MI                   Last Name                                                    Suffix 

 Street or Mailing Address                                        City                     State Zip Code                      Country 
 
 First Name                                  MI                   Last Name                                                    Suffix 

 Street or Mailing Address                                        City                     State Zip Code                      Country 
 
 First Name                                  MI                   Last Name                                                    Suffix 

 Street or Mailing Address                                        City                     State Zip Code                      Country 
                                                            Form 802─  Page 4 of   5 

 7. 	 The names, addresses, and titles of all officers of the corporation are:  (The offices of president and secretary 
  must be filled, but both may not be held by the same officer.) 
                           (If additional space is needed, include the information as an attachment to this form for item 7.)  
                                                                                                                               Officer Title 
                                                                                                                               President 
 First Name                            MI     Last Name                                      Suffix 

 Street or Mailing Address                              City                         State   Zip Code                           Country 
 
                                                                                                                               Officer Title 
                                                                                                                               Secretary 
 First Name                            MI     Last Name                                      Suffix 

 Street or Mailing Address                              City                         State   Zip Code                           Country 
 
                                                                                                                               Officer Title 
                                                                                                                                
 First Name                            MI     Last Name                                      Suffix 

 Street or Mailing Address                              City                         State   Zip Code                           Country 
  
 Execution: 
 The undersigned affirms that the person designated as registered agent has consented to the appointment.  The 
 undersigned signs this document subject to the penalties imposed by law for the submission of a materially 
 false or fraudulent instrument and certifies under penalty of perjury that the undersigned is authorized under 
 the provisions of law governing the entity to execute the filing instrument. 

 Date:                                                     
                                                  Signature of authorized officer 
 
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