Amended Annual Report (Foreign Non Profit Corp)

nonprofitforeignamendedannualreport Enter Filing Year Secretary of State Office 500 E Capitol Ave Pierre, SD 57501 (605)773-4845 1.Business ID and Name: Business ID Business Name You may amend any of the information below. If you are not amending a section, please leave that section blank. 2.The address of the principal executive office (business address). Actual Street Address City State ZIP+4 Mailing Address, if Different from Street Address City State ZIP+4 Email Address (Optional) 3.The names and business addresses of its principal officers and directors (governors). Principal Officer/Director/Governor Actual Street Address City State ZIP+4 Principal Officer/Director/Governor Actual Street Address City State ZIP+4 Principal Officer/Director/Governor Actual Street Address City State ZIP+4 4.Beneficial Interest (optional) Owner Description of Ownership Percentage/Value Owner Description of Ownership Percentage/Value No person may execute this report knowing it is false in any material respect. Any violation may be subject to a civil and/or criminal penalty (SDCL 22-39-36). Dated Signature of an authorized person Email (Optional) Printed Name AMENDED ANNUAL REPORT FOREIGN NONPROFIT CORPORATION SDCL 47-27-18 FILING FEE: $25 Make check payable to SECRETARY OF STATE American LegalNet, Inc. www.FormsWorkFlow.com