Secretary of State Office 
500 E Capitol Ave                                    ANNUAL REPORT 
Pierre, SD  57501                      DOMESTIC LIMITED  IABILITY L                OMPANYC  
(605)773-4845                                        SDCL 47-34A-211; 59-11-24, 24.1 
corpinfo@state.sd.us
                                                     FILING FEE: $65
                                       Additional Fee for Delinquent Reports: $50
   Enter Filing Year 

1. Business ID and Name:

   Business ID 

   Business Name

2. The jurisdiction under whose law it is formed     South Dakota 

3. The address of the principal executive office (business address).

   Actual Street Address                                                      City          State ZIP+4 

   Mailing Address, if Different from Street Address                          City          State ZIP+4 

   Email Address (Optional) 

4. The South Dakota Registered Agent’s name

   South Dakota law permits the registered agent to be either: A) noncommercial registered agent (this may be an
   individual) or B) a commercial registered agent.  Complete only one below, either (a) or (b).

   (a)  The South Dakota Noncommercial Registered Agent’s name

   Actual Street Address in this State                                        City          State ZIP+4 

   Mailing Address in this State, if Different from Street Address            City          State ZIP+4 

   Email Address (Optional) 

   (b)  When listing a Commercial Registered Agent, please state their CRA#. This number can be obtained from the
        Commercial Registered Agent.

   Commercial Registered Agent Name                                                         CRA# 

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5. If the LLC is manager-managed, list the names and addresses of its manager(s SDCL 59-11-24.   the). LLC is member-If
   managed, this     section may be left blank.

      Manager/Governor                     Actual Street Address                     City                              State ZIP+4 

      Manager/Governor                     Actual Street Address                     City                              State ZIP+4 

      Manager/Governor                     Actual Street Address                     City                              State ZIP+4 

6. Beneficial Interest (optional) - A beneficial owner is a person who has or in some manner controls an equity security.
   Please consult an attorney for legal advice if you have any questions concerning this entry. Any question under this
   heading is considered a request for legal advice and the Secretary of State’s office is, by statute, not permitted, to
   provide legal advice.

      Owner                                Address                                   City                              State ZIP+4 

      Owner                                Address                                   City                              State ZIP+4 

      Owner                                Address                                   City                              State ZIP+4 

No person may execute this report knowing it is false in any material respect.  Any violation may be subject to a criminal 
penalty (SDCL 22-39-36). 

Dated 
                                                                 Signature of an authorized person 

Email 
          (Optional)                                             Printed Name 

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                                                                                                                      Annualreportdomesticllc  Feb 2018