Annual Report Template

Domestic For Profit Corporation

PandaTip:  Most states require that corporations complete and submit an annual report that identifies key information about the corporation, including addresses and personnel.  This form covers the information most frequently needed, but you should confirm with the Secretary of State’s website for your state.  This form is for a domestic (within your own state) for profit corporation.

Corporation Name:                                                    Date Incorporated:

[CORPORATION NAME]                                      [INCORPORATION DATE]

Entity Number:                                                            FEIN:

[ENTITY NUMBER]                                                [FEIN NUMBER]

PandaTip:  Some states assign an entity or corporation number when a corporation is created; this number should appear on any filings with the Secretary of State’s office.  FEIN or EIN stands for the employer identification number that each corporation should have

Principal Place of Business (Physical Address):

[PRINCIPAL BUSINESS STREET ADDRESS 1]

[PRINCIPAL BUSINESS STREET ADDRESS 2]

[PRINCIPAL BUSINESS CITY], [PRINCIPAL STATE] [PRINCIPAL ZIP]

PandaTip:  There may be legal implications that attach to the location of your principal place of business, such as where a lawsuit may be brought, so be sure to provide the proper address.

Mailing Address:

[MAILING ADDRESS 1]

[MAILING ADDRESS 2]

[MAILING CITY], [MAILING STATE] [MAILING ZIP]

PandaTip:  Sometimes this is different from the physical address; you should provide both.

Name and address of Registered Agent:

[REGISTERED AGENT]

[RA STREET ADDRESS 1]

[RA STREET ADDRESS 2]

[RA CITY], [RA STATE] [RA ZIP]

PandaTip:  The Registered Agent for a corporation is an individual located within the state that is authorized to accept service of process, such as a summons and complaint if a lawsuit is filed against you or other time-sensitive official matters.  Select with care.  Make sure this person knows their responsibilities and isn’t going to be moving around or be otherwise hard to find.

Officers and Directors:

 President/CEO:

[PRESIDENT]

[PRESIDENT ADDRESS 1]

[PRESIDENT ADDRESS 2]

[PRESIDENT CITY], [PRESIDENT STATE] [PRESIDENT ZIP]

 Secretary:

[SECRETARY]

[SECRETARY ADDRESS 1]

[SECRETARY ADDRESS 2]

[SECRETARY CITY], [SECRETARY STATE] [SECRETARY ZIP]

Treasurer/CFO:

[TREASURER]

[TREASURER ADDRESS 1]

[TREASURER ADDRESS 2]

[TREASURER CITY], [TREASURER STATE] [TREASURER ZIP]

Director:

[DIRECTOR 1]

[DIRECTOR 1 ADDRESS 1]

[DIRECTOR 1 ADDRESS 2]

[DIRECTOR 1 CITY], [DIRECTOR 1 STATE] [DIRECTOR 1 ZIP]

Director:

[DIRECTOR 2]

[DIRECTOR 2 ADDRESS 1]

[DIRECTOR 2 ADDRESS 2]

[DIRECTOR 2 CITY], [DIRECTOR 2 STATE] [DIRECTOR 2 ZIP]

Director:

[DIRECTOR 3]

[DIRECTOR 3 ADDRESS 1]

[DIRECTOR 3 ADDRESS 2]

[DIRECTOR 3 CITY], [DIRECTOR 3 STATE] [DIRECTOR 3 ZIP]

PandaTip:  Most jurisdictions require identification of at least a President, Secretary, and Treasurer; this form also adds spaces for up to three directors.  Confirm with your Secretary of State’s office what you need to disclose in your annual report.  Keep in mind that in some states this information will also be publicly accessible.

I hereby certify under penalty of perjury of the laws of this state that the information listed above is true and correct to the best of my knowledge, and that I am an officer or director of this corporation with authority to sign and submit this report.

PandaTip:  There are penalties that may attach to failure to provide accurate information, so just make sure it is correct before signing and submitting it.

[SIGN DATE]                                         ______________________________

                                                                       [PERSON SUBMITTING REPORT]

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