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Indiana Business Entity Report 48725 - Indiana

Indiana Business Entity Report Form. This is a Indiana form and can be used in General Corporations Secretary Of State .
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INDIANA BUSINESS ENTITY REPORT State Form 48725 (R9 / 3-17) Approved by State Board of Accounts, 2017 SECRETARY OF STATE BUSINESS SERVICES DIVISION 302 West Washington Street, Room E018 Indianapolis, IN 46204 Telephone: (317) 232-6576 www.sos.in.gov INSTRUCTIONS: 1. All corporations must complete Sections A-H (Sections G and H are located on the reverse side of this form). 2. All LLCs and Master LLCs must complete Sections A-E and Section H. Series do not file Business Entity Reports. 3. Please TYPE or PRINT in INK. 4. Make check or money order payable to the Secretary of State. 5. Submit original completed paperwork to: 302 West Washington Street, Room E-018, Indianapolis, IN 46204. 6. File report online with a credit card. Refer to www.sos.in.gov. INFORMATION CONTAINED ON THIS PAGE IS NOT PART OF THE PUBLIC RECORD. Name of business E-mail address of business (SOS use only) RETURN DOCUMENTS TO: Name Street address, line 1 Street address, line 2 City State ZIP code Telephone number E-mail address (If different from above ­ SOS use only) ( ) American LegalNet, Inc. www.FormsWorkFlow.com INDIANA BUSINESS ENTITY REPORT State Form 48725 (R9 / 3-17) Approved by State Board of Accounts, 2017 Indiana Code 23-1-18-3 23-17-29-3 23-18-12-3 SECTION A Current entity name and principal office address (number and street, city, state, and ZIP code) Please make any changes to address here. * * Entity name cannot be changed on this report. SECTION B Current filing year Past filing years reported on this form SECTION C Date of incorporation / qualification / formation (month, day, year) State of domicile SECTION D (Please check the appropriate type for your corporate entity.) Business Corporation Professional Corporation Nonprofit Corporation SECTION E Current registered agent and registered address ** Please make changes to agent and address here. Ag Coop Limited Liability Company (LLC) Master LLC ** P.O. box is not an acceptable address unless accompanied by a rural route number. SECTION F Current President or highest officer and address (number and street, city, state, and ZIP code) Please make changes to officer and address here. Current Secretary or other officer and address (number and street, city, state, and ZIP code) Please make changes to officer and address here. Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com SECTION G (Please list the name(s) and address(es) of current director(s). If necessary, attach an additional sheet.) Name of Director Street Address (number and street) City State ZIP Code SECTION H (This must be signed by a corporate officer, chairman of the board, registered agent, certified public accountant or an attorney employed by the entity or by a member of manager of the LLC.) Required if registered agent information was updated: By checking the box, the signator(s) represent(s) that the registered agent named in the application has consented to the appointment of the registered agent. In Witness Whereof, the undersigned executes this Indiana Business Report and verifies, subject to penalties of perjury, that the statements contained herein are true, this ______ day of ________________________, 20______. Signature Printed name FEE SCHEDULE FOR-PROFIT CORPORATIONS (Domestic and Foreign) AND LIMITED LIABILITY COMPANIES (Domestic and Foreign) All above-named entities must file a biennial report with the Secretary of State. The fee is $50.00 for a two-year registration. The report is due in the anniversary month of registration. Entities registered in an even year must file every even year. Entities registered in an odd year must file every odd year. NONPROFIT CORPORATIONS All nonprofit corporations (domestic and foreign) must file a biennial report with the Secretary of State. The fee is $20.00 for a two-year registration. Nonprofit corporations that were formed January 1 through June 30 will file their first biennial report, with the $20.00 filing fee, in 2017 and in each odd year going forward. Nonprofit corporations that were formed July 1 through December 31 will file their first biennial report, with the $20.00 filing fee, in 2016. These entities will file their next biennial report in 2018 and in each even year going forward. LIMITED LIABILITY PARTNERSHIPS, LIMITED PARTNERSHIPS, AND SERIES These entities do not file corporate reports. Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com
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