DOMESTIC PROFIT CORPORATION
RETURN TO: NM PUBLIC REGULATION COMMISSION CORPORATIONS BUREAU P.O. BOX 1269 SANTA FE NM 87504-1269 BIENNIAL REPORT_______ For taxable year ending_____/____/_______
SUPPLEMENTAL REPORT_______( if any information changes)
Please see instructions on back of page.
1 EXACT CORPORATE NAME AND U.S. MAILING ADDRESS 2 Name Address City, State, Zip
NMPRC Certificate of Incorporation No.
Principal Place of Business in New Mexico Street City, Zip
4 REGISTERED AGENT AND OFFICE LOCATION WITHIN NEW MEXICO FOR SERVICE OF PROCESS (Filing corporation cannot be its own agent) Name Street Address City, Zip 5 TAX ID NUMBER 6 NEXT ANNUAL MEETING
7 DIRECTORS AND OFFICERS List the names and addresses of ALL the directors and officers and identify every title each director holds. A New Mexico corporation shall consi