JAY DARDENNE SECRETARY OF STATE
STATE OF LOUISIANA SECRETARY OF STATE
Commercial (225) 925-4704 (225) 922-0435 Fax Administrative Services (225) 925-4704 (225) 925-4726 Fax Uniform Commercial Code (225) 922-1193 (225) 922-0452 Fax
TRANSMITTAL INFORMATION For All Business Filings
Business Name (List exactly as it appears in documents)
Name of person filing document (evidence of filing will be mailed to this person, at address below)
Address
City
State
Zip Code
Daytime phone number
Fax number
Email address
NOTE: Louisiana Law requires all Louisiana notaries to print or type their name and notary or bar roll number on the document.
Mailing Address: P. O. Box 94125, Baton Rouge, LA * 70804-9125 Office Location: 8585 Archives Ave., Baton Rouge, LA * 70809 Web Site Address: www.sos.louisiana.gov
SS984 Rev. 10/08
Jay Dardenne Secretary of State
CORPORATION/LIMITED LIABILITY COMPANY SUPPLEMENTAL INITIAL REPORT
(R.S. 12:25 & R.S. 12:1305)
Enclose $25.00 filing fee Make remittance payable to Secretary of State Do Not Send Cash Return to: Commercial Division P. O. Box 94125 Baton Rouge, LA 70804-9125 Phone (225) 925-4704 Web Site: www.sos.louisiana.gov
1. The name of this company is: _____________________________________________________________ 2. The names and municipal addresses (not a P.O. Box only) of the first directors (corporation) or managers or members (limited liability company) are:
Name
Address
Name
Address
Name
Address
Name
Address Corporations: LLC: To be signed by incorporator(s) or shareholder(s): To be signed by each person who signed the Articles of Organization:
Date
SS366 Rev. 03/08 (see instructions on back)
INSTRUCTIONS
Corporations
1. If a corporation's first directors are not named in the Initial Report, a Supplemental Report must be filed after they are selected. The Supplemental Report shall set forth the name and address of each director, and shall be signed by each incorporator, or by any shareholder. A multiple original of the Supplemental Report, or a copy certified by the Secretary of State, shall be filed for record in the office of the recorder of mortgages of the parish in which the registered office of the corporation is located.
2.
Limited Liability Company
1. If a limited liability company's initial managers or members are not named in the Initial Report, a Supplemental Report must be filed after they are selected. The Supplemental Report shall set forth the name and address of each manager or member. The Supplemental Report shall be signed by each person who signed the Articles of Organization.
2.