Corporation Or Limited Liability Company Supplemental Initial Report {366}

CORPORATION/LIMITED LIABILITY COMPANY SUPPLEMENTAL INITIAL REPORT(R.S. 12:25 & R.S. 12:1305) Enclose $25.00 filing fee Return to: Commercial Division Make remittance payable to P. O. Box 94125 Secretary of State Baton Rouge, LA 70804-9125 Do Not Send Cash Phone (225) 925-4704Web Site: www.sos.la.gov1. 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: Corporations: To be signed by incorporator(s) or shareholder(s):LLC: To be signed by each person who signed the Articles of Organization:DateSS366 Rev. 09/11(see instructions on back) INSTRUCTIONS Corporations1.If a corporation222s 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.2.A copy of the Supplemental Report 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. Limited Liability Company1.If a limited liability company222s 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.2.The Supplemental Report shall be signed by each person who signed the Articles of Organization. www.FormsWorkflow.com