Enter Filing Year                                 ANNUAL REPORT 
Secretary of State Office           FOREIGN NONPROFIT  ORPORATIONC
500 E Capitol Ave                                     SDCL 47-27-18, 59-11-24 to 26 
Pierre, SD 57501 
(605)773-4845
corpinfo@state.sd.us                                  FILING FEE:$10 
                                     Make check payable to SECRETARY OF STATE 

1. Business ID and Name:

Business ID

Business Name
2. The jurisdiction under whose law it is formed

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) a noncommercial registered agent (this may be an
individual), B) a commercial registered agent, or C) an office holder.  Complete only one below, either (a) or (b) or (c).

(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# 

(c) Title of the office or other position with the business:
                                                                                           ____________  
Business Office’s 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) 

                                                                Page  1 of  2

5.The names and addresses of its principal officers and directors (governors).

Principal Officer/Director/Governor Actual Street Address                     City             State ZIP+4 

Principal Officer/Director/Governor Actual Street Address                     City             State ZIP+4 

Principal Officer/Director/Governor Actual Street Address                     City             State ZIP+4 

Principal Officer/Director/Governor Actual Street Address                     City             State ZIP+4 

6.Beneficial Interest (optional)

Owner                               Description of Ownership                                   Percentage/Value 

Owner                               Description of Ownership                                   Percentage/Value 

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

Dated 
                                                             Signature of an authorized person 

Email 
      (Optional)                                             Printed Name 

                                    Page  2 of  2
                                                                                               annualreportforeignnonprofit Feb 2018