Filing Number: _________________
                 John Thurston, Arkansas Secretary of State 

                 ANNUAL CORPORATION FRANCHISE TAX REPORT 20                                                                                            23 
                 Non-Stock Corporation 
                 For the year ending 12/31/2022
Reports and taxes are due on or before      May  ,12023.  Penalty and interest will be due for reports if the United States Postal 
Service’s postmark is after the deadline. Complete this report online at www.sos.arkansas.gov, or sign in black ink and mail to 
the address listed below. 
1.  Business Name  and Address: 
                                                                                                                              Save Time & File Online  
Name:                                                                                                                         Anytime Day Or Night At 

Address:                                                                                                                      www.sos.arkansas.gov 

City, State, Zip:                                                    5. Current Names of Corporate Governors:
                                                                     President:
2. Correct any of the below information, if needed:
                                                                     Vice President:
Tax Contact Name:
                                                                     Secretary:
Address:
                                                                     Treasurer:
Address 2:
                                                                     Controller:
City, State, Zip:
                                                                     Tax Preparer:
Phone # of Tax Contact:

E-mail Address:                                                                                               Nature of Business:  
                                                                                                              Federal Tax ID#:

    ALL INFORMATION IN SECTIONS 3-5 
                 BELOW REQUIRED    

3. Registered Agent Information:
Name:
Address:
Address 2:
City, State, Zip:
4.Principal Office Information (in  Arkansas):
Address:
City, State, Zip:

 CORPORATIONS WITHOUT AUTHORIZED  TOCK S              AYP            $300.00                                                        TOTAL DUE          $300.00 

    I declare, under the penalties of perjury, that the foregoing statements are true to the best of my knowledge and belief. 
    Executed this     ______________ day of _________________________,_____________                                                 
                             (Day)                          (Month)                                                       (Year)  
     Print Name____________________________________________ Signature____________________________________________ 
                      Must be printed in black ink by: Pres., Vice Pres., Sec., Treas., Cont., or Tax Preparer      Must be signed in black ink by: Pres., Vice Pres., Sec., Treas., Cont., or Tax Preparer      

             Due on or before May 1, 20            23 – Penalty and interest due after May 1, 20                                           23 
                                       You may file this online at www.sos.arkansas.gov 
                      Remittance must accompany this report • Make checks payable to Arkansas Secretary of State 
                                          Phone: 501-682-3409 or Toll Free: 888-233-0325 
            Mail to: Business and Commercial Services Division • P.O. Box 8014 • Little Rock, Arkansas 72203-8014 
                                                                                                                                                          Rev. 12/22

        ARKANSAS ANNUAL FRANCHISE TAX REPORT – Non-Stock Corporation 

                                  DUE ON OR BEFORE MAY 1 

   Mail Payment To:  Business and Commercial Services P.O., Box 8014, Little Rock, Arkansas 72203 
                Online Filing, Payment, and Information: www.sos.arkansas.gov 
                       Phone: 501-682-3409 or Toll Free: 888-233-0325 

   WHO FILES ANNUAL FRANCHISE TAX REPORTS: All domestic and foreign corporations, associations, 
   organizations,  and  companies  constituting  a  separate  legal  entity  of  relationship  with  the  purpose  of 
   obtaining a privilege or franchise which is not allowed to them as individuals except those exempted by 
   A.C.A.  § 26-54-102. The only exemptions are nonprofit corporations, which are organizations exempt from
   the federal income tax, or organizations formed pursuant to the Uniform Partnership Act, A.C.A. § 4-46-
   101 et seq., or the  Uniform Limited Partnership Act, A.C.A. § 4-47-101 et seq.

1. Business  Name  and  Address:  The  domestic  corporation’s  name  as  it  appears  in  the    Articles  of
   Incorporation or the foreign corporation’s name as it appears in the Application for Certificate of Authority.
   a)   DOMESTIC  CORPORATION:       A  corporation  that  has  filed  its  original             Articles  of  Incorporation  in
        Arkansas.
   b)   FOREIGN CORPORATION: A corporation that has filed its original articles of incorporation anywhere
        other than Arkansas and has qualified to receive a Certificate of Authority in Arkansas.
2. Tax  Contact  Name,  Address,  and  Contact  Information:                 Person  or  firm  designated  to  receive  the
   corporation’s annual franchise tax reporting notifications. Please provide a name, address, phone number,
   and email address.
   a)   RESPONSIBILITY: Corporations not receiving a form by March 20                            must make a written request for
        paper forms. Fillable PDF forms can be downloaded, or franchise taxes can be filed online, through
        the Secretary of State’s website at www.sos.arkansas.gov. All corporations must comply with the
        May 1 due date.
   b)   REPORTING YEAR: The year in which the report is due.
   c)   TAX YEAR: The year ending December 31 preceding the reporting year.
   d)   TAX COMPUTED IN ERROR: Underpayment will be billed to the corporation. Requests for refunds
        must be submitted with proof to the Secretary of State's Business and Commercial Services Division
        at the above address.
   e)   EXTENSIONS: Acts 1046 and 1140 of 1991 eliminated the opportunity to request an extension. ALL
        REPORTS ARE DUE ON OR BEFORE MAY 1.
   f)   FAILURE TO FILE REPORT: Per A.C.A. § 26-54-107 and 114, corporations shall pay an additional
        penalty plus interest for late filing of the report or late payment of the tax. In order to be considered
        timely, tax reports and payments must be received by the Secretary of State's office no later than
        the close of business on May 1 or must be postmarked by the United States Postal Service no later
        than midnight on May 1. Postage meter dates are not acceptable for the purpose of determining the
        timely receipt of a tax form and/or payment. See A.C.A. § 26-18-105.

        Calculate late franchise taxes, interest, and penalties: 
              A.  Original Tax (Due May 1)                               $____________________ 
              B. Late Filing Penalty                                  + $25.00
              C. Tax and Penalty total                                = $____________________ 
              D. Interest: (C) x .000274 x (# of Days Deficient)  = $____________________
              E. Total Tax Due: (C)+(D)                               = $____________________ 

                                                                                                  Rev. 12/22

      If you have any questions determining your payment and/or late fees, please contact the Secretary 
      of State’s office at 501-682-3409 or Toll Free: 888-233-0325. 
3. Identical Information: If ALL of the information in Sections #4, #5, #6, and #7 is identical as set forth in 
   the prior year’s annual report, you may simply check box #3 on the form, sign the report and submit the 
   report with payment.
4. Registered Agent Information: The registered agent is a person or entity designated by the corporation 
   to receive any service of legal action or other official communication on its behalf. Many corporations use 
   its attorney or a professional corporate service company for this service. The registered agent’s address 
   must be a street address in Arkansas, and the agent must be located at that address. A post office box or 
   “mail drop” may NOT be used as the registered agent address. For more information on registered agents, 
   please refer to A.C.A. § 4-20-101 et seq.
5. Principal Office Information: Address of place of business of the executive offices of the corporation.
6. Current  Names  of  Corporate  Governors:  Names  of  the  corporation’s  president,  vice  president, 
   secretary, treasurer, controller, and tax preparer.
7. Foreign Corporation Information:
   a) Date of Qualification: The date of incorporation anywhere other than the State of Arkansas.
   b) State of Incorporation: Where the original articles of incorporation were filed, anywhere other than 
      Arkansas
   c) Nature of Business: The type of sector or industry to which the corporation belongs.
8. Corporations Without Authorized Stock Pay $300.00: Reference A.C.A. § 26-54-104 (5)
9. SIGNATURE: Corporation reports shall be signed in  black ink by one of the following: president, vice 
   president, secretary, treasurer, controller, other authorized person, or the tax preparer.

ADDITIONAL INFORMATION 
1. AMENDMENTS: Changes,  such  as  name,  merger,  etc.,  must  be  filed  through  the  Secretary  of  State
   Business and Commercial Services Division. Notations on the annual report form will not suffice. Forms
   for  changes  may  be  obtained  online  at  www.sos.arkansas.gov,  or  by  writing  or  calling  the  Arkansas
   Secretary of State Business and Commercial Services Division.
2. DISSOLUTION OR WITHDRAWAL:      Any corporation wishing to cease operations must file a dissolution
   or withdrawal document through the Business and Commercial Services of Secretary of State. See
   above for contact information.

                                                                                                  Rev. 12/22