Free First Report - New Mexico

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RETURN TO: NM PUBLIC REGULATION COMMISSION CORPORATIONS BUREAU P.O. BOX 1269 SANTA FE NM 87504-1269 See instructions on back of page. 1 Name EXACT CORPORATE NAME Address AND U.S. MAILING City, State, Zip ADDRESS
2 NMPRC Certificate of Authority Number 3

FOREIGN NONPROFIT CORPORATION (1st)
INITIAL REPORT_______ For taxable year ending____/____/_____

State or country of incorporation

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Principal Office Outside New Mexico Street City, State, Zip

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Registered Office in State of Incorporation Street City, State, Zip

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REGISTERED AGENT AND OFFICE LOCATION WITHIN NEW MEXICO FOR SERVICE OF PROCESS (Filing corporation cannot be its own agent) Name Street Address City, Zip
BRIEF STATEMENT OF CHARACTER OF AFFAIRS BEING CONDUCTED IN NEW MEXICO

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DIRECTORS AND OFFICERS List the names and addresses of ALL the directors and officers and identify every title each director holds. (optional) Office/Title Name Address Additional Titles Director Director Director President Vice President Secretary Treasurer Attach schedule of additional directors and officers if needed
TWO SIGNATURES Under penalties of perjury, we declare and affirm that we have examined this report, including the accompanying schedules and statements, and that all statements contained therein are true and correct. Date Printed Name Signature Title

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PAYMENT OF FILING FEE AND LATE FILING PENALTY a Report filing fee b Late filing penalty ($10.00) PRC extension, if any, must be submitted with this report c TOTAL AMOUNT DUE with corporate report (lines a + b) PLEASE DO NOT SUBMIT CASH FOR PAYMENT

NMPRC USE ONLY $ 10.00 Amount Remitted $ Postmark Date

INSTRUCTIONS This report is required by, and must comply with the requirements of, NMSA 1978 Sections 53-8-82 and 53-883 and 12.3.3.12 NMAC. Please type or print legibly. At the top right of the form, indicate the closing date of the taxable year of the corporation. 1. 2. 3. Provide the exact name of the corporation and U.S. postal mailing address. Insert the Certificate of Authority number issued by the New Mexico Public Regulation Commission. Indicate the state or country under whose laws the corporation is incorporated.

4. Provide the address of your principal place of business outside New Mexico if different from the address of the registered office, or "NONE" if applicable. 5. Provide the registered office in the state or country under whose laws the corporation is incorporated.

6. Indicate the address of the registered office of the corporation in New Mexico, and the name of its registered agent at that address. For additional information on the requirements for registered office and agent, see NMSA 1978 Sections 53-8-71 and 53-8-72. If within a municipality, the address must be a street address; if outside a municipality, you must include geographic location, including well-known landmarks. 7. Provide a brief statement of the character of the affairs that the corporation is actually conducting in New Mexico. Attach additional pages if necessary. 8. Indicate the names and respective addresses of the directors and officers of the corporation. You must list any officers and titles required by the state or country under whose laws the corporation is incorporated. If the corporation's articles of incorporation or by-laws confer additional titles on the officers, you may provide these in the right column, but this is not required. 9. Any two of the directors or officers of the corporation, or a receiver or trustee if the corporation is in the hands of a receiver or trustee, must sign and swear to the statements in the report. 10. The Initial Report is due within thirty (30) days of the date on which the Commission issued your Certificate of Authority. If not filed by this date, you owe a late penalty of ten dollars ($10.00), unless the Commission granted an extension pursuant to the terms of NMSA 1978 Section 53-8-83. If the report is late and the Commission did not grant an extension, insert ten dollars ($10.00) in box 10b and total the fees owed. Payment of fees must accompany this report or the Commission will not accept it for filing. You may pay by check or money order made out to the New Mexico Public Regulation Commission. If the Commission granted an extension, you must attach a copy of the extension to this report. [12.3.3.12 NMAC - N, 7-15-05]