Annual Corporation Franchise Tax Report 2011 (Non-Stock Corporation) Form
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1Mark Martin, Arkansas Secretary of State
222222222
ANNUAL CORPORATION FRANCHISE TAX REPORT 2011
(Non-Stock Corporation)
For the year ending 12/31/2010
Reports and Taxes are due on or before May 1, 2011. 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 or sign in ink and mail to the address
listed below.
1.
Correct any information, if needed, in space provided below
2.
Tax contact name: ____________________________________
Save time, file online at anytime
Address: ____________________________________________
day or night at
Address Line 2: _______________________________________
.
City, State, Zip: _______________________________________
Phone # of tax contact: _________________________________
Date of Qualification: ________________________________
E-mail address: _______________________________________
State of Incorporation: _______________________________
Required Information
Nature of Business: _________________________________
Federal Tax ID# ______________________________________
3.
5.
Registered Agent Information:
___A
4 & 5
LL OF THE INFORMATION IN SECTION
HAS BEEN
VERIFIED AND HAS BEEN FOUND TO BE EXACTLY THE SAME
Name: ______________________________________
____
.
AS LAST YEARS REPORT
Address 1: _______________________________________
Address 2: _______________________________________
4.
Current names of corporate governors:
City, State, Zip: ___________________________________
President: ______________________________________
Principal Office Information:
Vice-President: __________________________________
Address: ________________________________________
Secretary: ______________________________________
City, State Zip: ___________________________________
Treasurer: ______________________________________
Controller:
____________________________________________
Tax Preparer:
_________________________________________
C
W
A
S
P
$300.00: T
D
$300.00
ORPORATIONS
ITHOUT
UTHORIZED
TOCK
AY
OTAL
UE
I declare, under the penalties of perjury, that the foregoing statements are true to the best of my knowledge and belief.
Signature________________________________________ Executed this _________ day of __________________, ____________
An officer or tax preparer listed in 4 above must sign this form in ink
(Day)
(Month)
(Year)
Due on or before May 1, 2011 – Penalty and Interest due after May 1, 2011
You may file this electronically over the Internet @
Remittance must accompany this report • Make Checks Payable to Arkansas Secretary of State
Phone 501-682-3409 or 1-888-233-0325
Mail to: Business and Commercial Services Division • P.O. Box 8014 • Little Rock, Arkansas 72203-8014
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