2012 Annual Report For Nonprofit Corporation - Arkansas Secretary Of State printable pdf download

2012 Annual Report For Nonprofit Corporation - Arkansas Secretary Of State

Arkansas Secretary of State

Mark Martin

State Capitol • Little Rock, Arkansas 72201-1094

501-682-3409 •

Business & Commercial Services, 250 Victory Building, 1401 W. Capitol, Little Rock

2012 ANNUAL REPORT FOR NONPROFIT CORPORATION

(PLEASE TYPE OR PRINT CLEARLY IN INK)

Report Due August 1

1. The name of the Nonprofit Corporation is:

2. The state or foreign country under whose laws the corporation was incorporated is:

3. Registered Agent for Service of Process

a. Name:

b. Registered Agent Address, MUST be physical address in the State of Arkansas:

4. Corporation’s Principal Office address:

5. Principal officers:

Name

Address

6. Board of Directors: (Minimum of three (3) persons)

Name

Address

7. Tax Contact Name & Mailing Address:

8. Is this entity registered with the IRS as an exempt organization?

(optional)

If yes, what type of exemption status is held?

(optional)

Attach additional directors if needed.

I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class

C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.

Executed this _________ day of __________________, ____________

(Day)

(Month)

(Year)

________________________________________________

_____________________________________________

Signature and Title of Authorized Director or Officer (Governor)

Printed Name of Authorized Director or Officer (Governor)

File online today at

NO FEE

NP-AR Rev. 09/11

2012 Annual Report For Nonprofit Corporation - Arkansas Secretary Of State