Free Complete Packet - Nevada


File Size: 549.1 kB
Pages: 6
Date: February 12, 2009
File Format: PDF
State: Nevada
Category: Secretary of State
Word Count: 2,380 Words, 14,417 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.sos.state.nv.us/business/forms/pdf/InitialListofOfficersProfitpk.pdf

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(PROFIT) INITIAL LIST OF OFFICERS, DIRECTORS AND REGISTERED AGENT OF
NAME OF CORPORATION FOR THE FILING PERIOD OF TO

FILE NUMBER

The entity's duly appointed registered agent in the State of Nevada upon whom process can be served is:

A FORM TO CHANGE REGISTERED AGENT INFORMATION CAN BE FOUND ON OUR WEBSITE:

www.nvsos.gov
USE BLACK INK ONLY - DO NOT HIGHLIGHT ABOVE SPACE IS FOR OFFICE USE ONLY

Return one file stamped copy. (If filing not accompanied by order instructions, file stamped copy will be sent to registered agent.)

**YOU MAY NOW FILE YOUR INITIAL LIST ONLINE AT www.nvsos.gov**
IMPORTANT: Read instructions before completing and returning this form.
1. Print or type names and addresses, either residence or business, for all officers and directors. A President, Secretary, Treasurer, or equivalent of and all Directors must be named. There must be at least one director. An Officer must sign the form. FORM WILL BE RETURNED IF UNSIGNED. 2. If there are additional officers, attach a list of them to this form. 3. Return the completed form with the $125.00 filing fee. A $75.00 penalty must be added for failure to file this form by the last day of the first month following the incorporation/initial registration with this office. 4. Make your check payable to the Secretary of State. Your canceled check will constitute a certificate to transact business. 5. Ordering Copies: If requested above, one file stamped copy will be returned at no additional charge. To receive a certified copy, enclose an additional $30.00 per certification. A copy fee of $2.00 per page is required for each additional copy generated when ordering 2 or more file stamped or certified copies. Appropriate instructions must accompany your order. 6. Return the completed form to: Secretary of State, 202 North Carson Street, Carson City, Nevada 89701-4201, (775) 684-5708. 7. Form must be in the possession of the Secretary of State on or before the last day of the first month following the initial registration date. (Postmark date is not accepted as receipt date.) Forms received after due date will be returned for additional fees and penalties. FILING FEE: $125.00 LATE PENALTY: $75.00

CHECK ONLY IF APPLICABLE
This corporation is a publicly traded corporation. The Central Index Key number is: This publicly traded corporation is not required to have a Central Index Key number.
NAME TITLE(S)

PRESIDENT (OR EQUIVALENT OF)
ADDRESS CITY STATE ZIP CODE

NAME

TITLE(S)

SECRETARY (OR EQUIVALENT OF)
ADDRESS CITY STATE ZIP CODE

NAME

TITLE(S)

TREASURER (OR EQUIVALENT OF)
ADDRESS CITY STATE ZIP CODE

NAME

TITLE(S)

DIRECTOR
ADDRESS CITY STATE ZIP CODE

I declare, to the best of my knowledge under penalty of perjury, that the above mentioned entity has complied with the provisions of NRS 360.780 and acknowledge that pursuant to NRS 239.330, it is a category C felony to knowingly offer any false or forged instrument for filing in the Office of the Secretary of State.

X
Signature of Officer

Title

Date

Reset

Nevada Secretary of State Initial List Profit Revised: 7-1-08

ROSS MILLER Secretary of State
202 North Carson Street Carson City, Nevada 89701-4201 (775) 684 5708 Website: www.nvsos.gov

Instructions for Initial List and Registered Agent Form

ATTENTION: You may now file your initial or annual list online at www.nvsos.gov
IMPORTANT: READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING FORM.

ATTENTION: Pursuant to NRS, the Initial List and Registered Agent form MUST be in the care,
custody and control of the Secretary of State by the close of business on the last day of the first month following the organization date. (Postmark date is not accepted as receipt date in the Office of the Secretary of State.)

As of November 1, 2003 the filing fee for a initial list is $125.00. Nonprofit corporation initial lists are $25.00.
TYPE or PRINT the following information on the Initial List and Registered Agent Form: 1. The FILE NUMBER and NAME of the entity EXACTLY as it is registered with this office. 2. The FILING PERIOD is the month and year of filing TO the month and year 12 months from that date. Example: if the entity date was 1/12/99 the filing period would be 1/1999 to 1/2000. 3. The name and address of the REGISTERED AGENT and OTHER names and addresses as required on The list should be entered in the boxes provided on the form. Limited-Liability Companies MUST Indicate whether MANAGER or MANAGING MEMBER is being listed. 4. The SIGNATURE, including his/her title and date signed MUST be included in the areas provided at the bottom of the form. 5. Completed FORM, FEES and applicable PENALTIES must be returned to the Secretary of State. Pursuant to NRS 225.085, all Initial and Annual Lists must be in the care, custody and control of the Secretary of State by the close of the business on the due date. Lists received after the due date will be returned unfiled, and will require any associated fees and penalties as a result of being late. Trackable delivery methods such as Express Mail, Federal Express, UPS Overnight may be acceptable if the package was guaranteed to be delivered on or before the due date yet failed to be timely delivered.
ADDITIONAL FORMS may be obtained on our website at www.nvsos.gov or by calling 775-684-5708. FILE STAMPED COPIES: To receive one file stamped copy, please mark the appropriate check box on the list. Additional copies require $2.00 per page and appropriate order instructions. CERTIFIED COPIES: To order a certified copy, enclose an additional $30.00 and appropriate instructions. A copy fee of $2.00 per page is required for each copy generated when ordering 2 or more certified copies. EXPEDITE FEE: Filing may be expedited for an additional $75.00 fee. Filing may be submitted at the office of the Secretary of State or by mail at the following addresses:

MAIN OFFICE:
Regular and Expedited Filings

SATELLITE OFFICES:
Expedited Filings Only

Secretary of State
Status Division 202 North Carson Street Carson City NV 89701-4201 Phone: 775-684-5708 Fax: 775-684-7123

Secretary of State ­ Las Vegas
Commercial Recordings Division 555 East Washington Ave, Suite 5200 Las Vegas NV 89101 Phone: 702-486-2880 Fax: 702-486-2888

Secretary of State - Reno
Commercial Recordings Division 1755 East Plumb Lane, Suite 231 Reno NV 89502 Phone: 775-688-1257 Fax: 775-688-1858

Nevada Secretary of State Form Initial List Instructions Revised on: 1-16-09

ROSS MILLER Secretary of State 202 North Carson Street Carson City, Nevada 89701-4201 (775) 684 5708 Website: www.nvsos.gov
SUBMIT THIS COMPLETED FORM WITH YOUR FILING

Customer Order Instructions
USE BLACK INK ONLY - DO NOT HIGHLIGHT

Processing Service Requested:
Name of Entity:

Regular

24-Hour Expedite

(additional fee included)

Date:

Return to: Contact Name: Return Delivery: Email to: Hold for Pick Up Other: (explain below) Mail to Address Above Phone:
(email or fax options do not receive a copy via mail; must be ordered separately)

Fax to: FedEx: Acct #

Order Description: (include items being ordered and fee breakdown)*

*PLEASE NOTE: this office keeps the original paperwork. The first file stamped copy ordered at the time of filing is at no charge. Each additional copy is $2.00 per page (plus $30.00 for each certification).

Total Amount:

Method of Payment: Check/Money Order eCheck/Credit Card (attach checklist) Trust Account:

Use balance remaining in job # Reset
Nevada Secretary of State Customer Order Instructions Revised: 9-26-08

ROSS MILLER Secretary of State 202 North Carson Street Carson City, Nevada 89701-4201 (775) 684 5708 Website: www.nvsos.gov
SUBMIT THIS COMPLETED FORM WITH YOUR FILING

1 or 2-Hour Expedite Customer Order Instructions
USE BLACK INK ONLY - DO NOT HIGHLIGHT

Processing Service Requested:
Name of Entity:

2-Hour Expedite
(additional $500.00 fee included)

1-Hour Expedite
(additional $1000.00 fee included)

Date:

Return to: Contact Name: Return Delivery: Email to: Hold for Pick Up Other: (explain below) Mail to Address Above Fax to: FedEx: Acct # Phone:

Order Description: (include items being ordered and fee breakdown)*

*PLEASE NOTE: this office keeps the original paperwork. The first file stamped copy ordered at the time of filing is at no charge. Each additional copy is $2.00 per page (plus $30.00 for each certification).

Total Amount:

Method of Payment: Check/Money Order eCheck/Credit Card (attach checklist) Trust Account:

Use balance remaining in job # Reset
Nevada Secretary of State 1-2 Hr Customer Order Instructions Revised: 9-25-08

ROSS MILLER Secretary of State
202 North Carson Street Carson City, Nevada 89701-4201 Phone: (775) 684 5708 Website: www.nvsos.gov

24-hour, 2-hour and 1-hour Expedite Service Guidelines

IMPORTANT: To ensure expedited service, please mark "Expedite" in a conspicuous place at the top of the service request. Please indicate method of delivery.

24-HOUR EXPEDITE SERVICE
The Secretary of State offers a 24-hour expedite service on most filings processed by this office. If you choose to utilize this service, please enclose with your filing the additional expedite fee. Please note that this expedite fee is in addition to the standard fee charged on each filing and/or order. Check the 24-hour expedite box on your customer order instruction form. If not using our order form, state clearly in your cover letter that you are requesting 24-hour expedited service, include your telephone number and return information. Attach the order form or cover sheet to the top of your filing and submit to this office. Each filing will be returned by U.S.P.S. regular mail unless other arrangements are made. This office does not fax confirmation of a 24-hour expedite. The fee for 24-hour handling ranges from $25.00 to $125.00. Please consult our fee schedules for the appropriate 24hour expedite fee. If you require assistance, please contact this office. Time Constraints: Each filing submitted receives same day filing date and may be picked up within 24-hours. Filings to be mailed the next business day if received by 2:00 pm of receipt date and no later than the 2nd business day if received after 2:00 pm. Expedite period begins when filing or service request is received in this office in fileable form.

2-HOUR EXPEDITE SERVICE
The Secretary of State offers a 2-hour expedite service on most filings processed by this office. If you choose to utilize the 2-hour expedite service, please enclose with your filing an additional $500.00 per filing and/or order. Please note that this expedite fee is in addition to the standard fee charged on each filing and/or order. Complete and submit the 2-hour customer order instruction form. If not using our order form, state clearly in your cover letter that you are requesting 2hour expedited service and include your telephone number and return information. Attach the order form or cover sheet to the top of your filing and submit to this office. Each filing will be returned by U.S.P.S. regular mail unless other arrangements are made.

1-HOUR EXPEDITE SERVICE
The Secretary of State offers a 1-hour expedite service on most filings processed by this office. If you choose to utilize the 1-hour expedite service, please enclose with your filing an additional $1000.00 per filing and/or order. Please note that this expedite fee is in addition to the standard fee charged on each filing and/or order. Complete and submit the 1hour customer order instruction form. If not using our order form, state clearly in your cover letter that you are requesting 1-hour expedited service and include your telephone number and return information. Attach the order form or cover sheet to the top of your filing and submit to this office. Each filing will be returned by U.S.P.S. regular mail unless other arrangements are made. 1-Hour and 2-Hour Time Constraints: Each filing submitted for either 1-hour or 2-hour expedite receives same day filing date and will be acknowledged by fax or e-mail within expedite service time. Failure to indicate method of acknowledgement (fax or e-mail) or to provide a correct fax number or e-mail address may prevent the Secretary of State from acknowledging the filing of such documents. Filings may be picked up within the expedite service period. Filings to be mailed will be mailed out no later than the next business day following receipt. Expedite period begins when filing or service request is received in this office in fileable form.

The Secretary of State reserves the right to extend the expedite period in times of extreme volume, staff shortages or equipment malfunction. These extensions are few and will rarely extend more than a few hours.
Nevada Secretary of State Expedite Guidelines Revised: 7-1-08

ROSS MILLER Secretary of State 202 North Carson Street Carson City, Nevada 89701-4201 (775) 684 5708 Website: www.nvsos.gov

ePayment Checklist
(For Counter, Fax and Mail Requests)
USE BLACK INK ONLY - DO NOT HIGHLIGHT

Service Type:

Counter

Mail

Fax (Expedite Processing Requires Additional Fees)

Order Processing Requested: Regular Processing

24-HOUR Expedite

2-HOUR Expedite

1-HOUR Expedite

Payment by Electronic Check
Account Type; Checking Savings Account Number: Routing Number:

(account holder name and address required below)

Amount of Electronic Check:

USD $

Payment by Card
Card Type: VISA

(card holder name and billing address required below)
MasterCard Discover American Express V CODE*

Customer Credit Card Number:

* 3-digit number found on the far right of the backside of VISA, MasterCard and Discover cards 4-digit number found on the front right side of American Express card.

NOTICE: For security and verification purposes, all credit card payments must include the 3 or 4-digit CVV2 code (VCode) number located on the credit card. Failure to include this code will result in the rejection of your filing or service request. Credit Card Expiration Date: Month Year

Amount to Charge Card:

USD $

Order Information (required)
Entity Name/Order Reference: Account/Card Holder Information:
Name as it Appears on the Account Billing Address City, State, Zip Telephone

Payment Authorization
I authorize the Secretary of State to bill an amount not to exceed the following to be charged to the above listed account(s):

X
Authorized Signature Reset

Not to Exceed Amount:

USD $

Nevada Secretary of State ePayment Checklist Revised: 2-9-09