Foreign Cooperative Annual Report Form - Sd Secretary Of State
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1SECRETARY OF STATE
FILE DATE ________________
ANNUAL REPORT
STATE CAPITOL
RECEIPT NO. ______________
FOREIGN COOPERATIVE
500 E. CAPITOL AVE.
PLEASE TYPE OR USE BLACK INK
PIERRE, S.D. 57501
Clear Form
(605)773-4845
FILING FEE: $30 MAKE CHECK PAYABLE TO SECRETARY OF STATE
Fax (605)773-4550
ADDITIONAL PENALTY FEE OF $50 APPLIES TO ALL LATE FILINGS
Print
1. Corporate Name, and Address:
Federal Taxpayer ID # __________________
FILING DATE: Due during the month the
Certificate of Incorporation was issued, and
delinquent after the last day of the following
month.
2. The address of the cooperative’s principal office in the state under which the cooperative was incorporated:
3. The name of its registered agent in South Dakota:
Address of its registered office:
Zip +4
4. The names and addresses of its directors and officers:
NAME
OFFICE
STREET ADDRESS
CITY
STATE
ZIP+4
Director
Director
Director
President
Vice President
Secretary
Treasurer
General Manager
5. A statement by class and par value of the amount of stock it has authority to issue.
NUMBER OF SHARES CAN ISSUE
CLASS
PAR VALUE
6. NUMBER OF SHARES ISSUED
CLASS
PAR VALUE
7. The general type of business engaged in during the year:
The information herein contained shall be given as the date of the execution of the report and signed by a principal officer or the general manager.
_________________
____________________________________________________________
Dated
(Signature)
_____________________________________________________________
(
Title)
foreigncooperativeannualreport July 2005
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