Free RETURN TO - South Dakota

Secretary of State Office 500 E Capitol Ave Pierre, SD 57501 (605)773-4845

ANNUAL REPORT
DOMESTIC L.L.C.
Please Type or Print Clearly in Ink

FILE DATE

____________________

RECEIPT NO ___________________

FILING FEE: $50 Make check payable to SECRETARY OF STATE
1. L.L.C. ID and Name:

Clear Form

Search for Corporate ID, Name and Agent

HELP
Telephone # ____________________ FAX # _______________________

FILING DATE: Due during the month the Certificate of Organization was issued, and delinquent after the last day of the following month.

2. The address of the principal executive office in or out of the State of South Dakota. ______________________________________________________________________________________________
Street Address City State ZIP+4

______________________________________________________________________________________________
Mailing Address (Optional) City State ZIP+4

3. The name of the South Dakota Registered Agent _______________________________________________________ ______________________________________________________________________________________________
Street Address (Required to be a South Dakota Address) City State ZIP+4

______________________________________________________________________________________________
Mailing Address (Optional ­ Required to be a South Dakota Address) City State ZIP+4

4. The names and business addresses of its managers. If the L.L.C. is member-managed the names and addresses of the members need not be set forth. ______________________________________________________________________________________________
Manager Street Address City State ZIP+4

______________________________________________________________________________________________
Manager Street Address City State ZIP+4

______________________________________________________________________________________________
Manager Street Address City State ZIP+4

Dated ____________________________

__________________________________________________________ (Signature of an Authorized Manager or Member) __________________________________________________________ (Printed Name) __________________________________________________________ (Title)

Annualreportdomesticllc July2008