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!
State of Rhode Island This legal document
Department of State - Business Services Division should be typed.
All illegible
documents
Instructions for Filing will be REJECTED.
Annual Report for a Corporation
Section 7-1.2-1501 of the General Laws of Rhode Island, 1956, as amended

How to complete the form: How to pay the filing fee:
1. List the entity’s ID number. The ID number can be found The filing fee is payable either by mail via check made
by looking up your entity in the Corporate Database. payable to RI Department of State or in person via cash,
Please include this number on your check and refer to it credit card, or check at the Business Services Division, 148
in any future correspondence or filings with the Business W. River Street, Ste. 1, Providence, RI 02904. Contact our
Services Division. office at (401) 222-3040 for further information.
2. List the name of the corporation. The entity name can
be verified through our Corporate Database. If the entity How to confirm your filing:
name has changed, an amendment, form 101 or form
Entity records are retrievable and viewable through our
151, must be filed with this office. Electronic filing is
website. Successful filings will NOT result in a mailed
available.
confirmation. Filings that cannot be processed will be posted
3. List the address of the principal office of the corporation. online and then returned. To confirm your submission and
4. Enter the six digit NAICS code that describes the primary obtain evidence of your filing:
type of business in which the entity engages. Download • Go to our Corporate Database.
our NAICS Code List. • Enter the name or ID number of your entity and click
5. List the state or country of incorporation. “Search.”
6. Provide a brief statement of the character of business in • Click on the link to your entity record, scroll down,
which the corporation is actually engaged in this state. select “All Filings” and then “View Filing.”
If the corporation is inactive, this section must still be • Identify the desired type of filing and click on “PDF”
completed. under “View PDF” to view and print the record.
7. List the names and respective addresses of the officers
of the corporation. Do not leave areas blank. If the How to maintain your status:
answer is none, write “none.” If additional space is
The entity is responsible for filing an annual report each
needed, check the box and include the entity ID number
calendar year, excluding the year of incorporation, between
on the attachment.
February 1 and May 1. A courtesy reminder will be mailed
8. List the names and respective addresses of the directors to the registered agent prior to February 1 of each year.
of the corporation. Do not leave areas blank. If the Be sure to follow up with your registered agent concerning
answer is none, write “none.” If additional space is the filing of this report. Failure to file an annual report or
needed, check the box and include the entity ID number maintain a registered agent/office will result in revocation
on the attachment. proceedings.
9. The corporation’s exact number of authorized shares
is of record in this office and can be found on the entity Every entity registered with the RI Department of State -
summary screen. If there has been a change in the Business Services Division will have filing requirements with
authorized shares of the corporation, please contact our the Rhode Island Division of Taxation, even if no business
office. is conducted within Rhode Island for a particular year. Your
business may require additional licensing. Please visit our
10. Provide the number of issued shares along with the
website for further information.
class, series and par value on the form. Do not leave
this area blank. If the answer is none, write “none.”
11. This report must be executed on behalf of the corporation
by an authorized representative. If the corporation is in
the hands of a receiver or trustee, this report must be
executed on behalf of the corporation by the receiver or
trustee.
12. An Authorized Representative MUST sign and date the
form.

FORM 630- Revised: 04/2023

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            State of Rhode Island
            Department of State - Business Services Division
                                                                                                                   STAMP
Annual Report for the year:
Corporation                                                                                                        FOR
                                                                                                                   SECRETARY OF STATE 
                                                                                                                   USE ONLY
        Filing period: February 1 - May 1  
        Filing Fee:  $50.00             
        Penalty:  Additional $25.00 fee if form is not filed by May 31.
1. Entity ID Number                     2. Exact name of the Corporation

3. Principal Office Address                                             City                            State         Zip

4. NAICS Code                           6. Brief description of the character of business conducted in Rhode Island

5. State of Incorporation

7. List ALL officers (names and addresses)                                                                                Check the box to indicate an attachment 
President Name                                                          Vice-President Name

Street Address                                                          Street Address

City                                    State           Zip             City                            State         Zip

Secretary Name                                                          Treasurer Name

Street Address                                                          Street Address

City                                    State           Zip             City                            State         Zip

8. List ALL directors (names and addresses)                                                                              Check the box to indicate an attachment
Director Name                                                           Director Name

Street Address                                                          Street Address

City                                    State           Zip             City                            State         Zip

Director Name                                                           Director Name

Street Address                                                          Street Address

City                                    State           Zip             City                            State         Zip

9. Shares Authorized                                    10. Shares Issued                                  Check the box to indicate an attachment
This information is currently of record in the                        NUMBER OF SHARES                                               CLASS/SERIES                                              PAR VALUE
Department of State. 
Changes require an additional filing.
                               
11. This report must be executed on behalf of the corporation by an authorized representative. If the corporation is in the hands of a re                                                               -
ceiver or trustee, this report must be executed on behalf of the corporation by the receiver or trustee.
Under penalty of perjury, I declare and affirm that I have examined this report, including any accompanying schedules and 
statements, and that all statements contained herein are true and correct.
Name of Authorized Representative                                                                       Date

Signature of Authorized Representative

MAIL TO:
Division of Business Services
148 W. River Street, Providence, Rhode Island 02904-2615
Phone: (401) 222-3040 
Website: www.sos.ri.gov                                                                                            FORM 630- Revised: 04/2023

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            State of Rhode Island
            Department of State - Business Services Division

The Department of State tracks the number of new business filings on a quarterly and an annual basis. 
We are seeking more information from corporations and hope these three voluntary questions will help us better present useful 
trends and information on the health of our economy:

Entity ID Number:                 Name of the Corporation:

1. Does the business owner self-identify as any of the following:

             Woman
             Veteran
             Disabled
        Member of a socially and economically disadvantaged group (i.e., as defined under the US Small Business 
        Administration’s 8(a) Program:  Black, Hispanic, Native American, Asian Pacific or Subcontinent Asian American)

2. How many full-time employees does the business have:

           0
           1-5
           6-50
           51-200
           201-500
          Over 500

3. What are the gross revenues for the business for the past year:

           $0-$50,000
           $51,000-$250,000
           $251,000-$500,000
           $501,000-$1,000,000
           Over $1,000,000

Please note that all records maintained by or kept on file by the Department of State shall be public 
records unless exempt from disclosure in accordance with RIGL 38-2 Access to Public Records.

MAIL TO:
Division of Business Services
148 W. River Street, Providence, Rhode Island 02904-2615
Phone: (401) 222-3040 
Website: www.sos.ri.gov 
                                                                                                      FORM 630- Revised: 04/2023

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        State of Rhode Island
        Department of State - Business Services Division

Filer Contact Information
        
In the event our office needs more information in order to complete the filing of this document, we ask 
for the filer’s contact information. All fields are REQUIRED.

Name:                                                               Date:

Entity Name:

Street Address:

City:                                                        State: Zip Code:

Email Address:                                                      Phone Number:

If you have any questions, please call us at (401) 222-3040, Monday 
through Friday, between 8:30 a.m. and 4:30 p.m., or email 
corporations@sos.ri.gov.
                                                                         FORM 630- Revised: 04/2023

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