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     SouthDakota                 

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.   theIfLLC 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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                                                                                                       Annualreportdomesticllc  Feb 2018