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Arkansas Annual Franchise Tax Report Form - Non-Stock Corporation Form - Business And Commercial Services Page 2

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.

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.

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.

Principal Office Information: Address of place of business of the Limited Liability Company in Arkansas.

Current Names of Corporate Governors: Names of the corporation’s president, vice president,

secretary, treasurer, controller, and tax preparer.

Foreign Corporation Information:

Date of Qualification: The date of incorporation anywhere other than the State of Arkansas.

State of Incorporation: Where the original articles of incorporation were filed, anywhere other than

Arkansas

Nature of Business: The

type of sector or industry to which the corporation belongs.

Corporations Without Authorized Stock Pay $300.00: Reference A.C.A. § 26-54-104 (5)

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 , 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. 12/16

Arkansas Annual Franchise Tax Report Form - Non-Stock Corporation Form - Business And Commercial Services Page 2