Secretary of State Office 
                                                  ANNUAL REPORT 
500 E Capitol Ave 
Pierre, SD 57501                    FOREIGN 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

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. If the LLC is member-
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)

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 criminal 
penalty (SDCL 22-39-36). 

Dated 
                                                               Signature of an authorized person 

Email 
      (Optional)                                               Printed Name 

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                                                                                                  Annualreportforeignllc Feb 2018