"Periodic Report - Sample" - Colorado

Periodic Report - Sample is a legal document that was released by the Colorado Secretary of State - a government authority operating within Colorado.

Form Details:

  • Released on August 11, 2010;
  • The latest edition currently provided by the Colorado Secretary of State;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Colorado Secretary of State.

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Download "Periodic Report - Sample" - Colorado

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Form must be filed electronically.
Paper forms are not accepted.
This copy is a sample and cannot be submitted for filing.
Periodic Report
filed pursuant to §7-90-301, et seq. and §7-90-501 of the Colorado Revised Statutes (C.R.S)
ID number:
______________
Entity name:
______________________________________________________
Jurisdiction under the law of which the
entity was formed or registered:
______________________________________________________
1. Principal office street address:
______________________________________________________
(Street name and number)
______________________________________________________
____
__________________________ _
____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
(Country – if not US)
2. Principal office mailing address:
______________________________________________________
(if different from above)
(Street name and number or Post Office Box information)
______________________________________________________
_____
__________________________
____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
(Country – if not US)
3. Registered agent name:
____________________ ______________ ______________ _____
(if an individual)
(Last)
(First)
(Middle)
(Suffix)
OR
(if a business organization)
______________________________________________________
4. The person identified above as registered agent has consented to being so appointed.
5. Registered agent street address:
______________________________________________________
(Street name and number)
______________________________________________________
__________________________ CO
____________________
(City)
(State)
(Postal/Zip Code)
6. Registered agent mailing address:
______________________________________________________
(if different from above)
(Street name and number or Post Office Box information)
______________________________________________________
_____
__________________________
____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
(Country – if not US)
REPORT
Page 1 of 2
Rev. 8/11/2010
Form must be filed electronically.
Paper forms are not accepted.
This copy is a sample and cannot be submitted for filing.
Periodic Report
filed pursuant to §7-90-301, et seq. and §7-90-501 of the Colorado Revised Statutes (C.R.S)
ID number:
______________
Entity name:
______________________________________________________
Jurisdiction under the law of which the
entity was formed or registered:
______________________________________________________
1. Principal office street address:
______________________________________________________
(Street name and number)
______________________________________________________
____
__________________________ _
____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
(Country – if not US)
2. Principal office mailing address:
______________________________________________________
(if different from above)
(Street name and number or Post Office Box information)
______________________________________________________
_____
__________________________
____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
(Country – if not US)
3. Registered agent name:
____________________ ______________ ______________ _____
(if an individual)
(Last)
(First)
(Middle)
(Suffix)
OR
(if a business organization)
______________________________________________________
4. The person identified above as registered agent has consented to being so appointed.
5. Registered agent street address:
______________________________________________________
(Street name and number)
______________________________________________________
__________________________ CO
____________________
(City)
(State)
(Postal/Zip Code)
6. Registered agent mailing address:
______________________________________________________
(if different from above)
(Street name and number or Post Office Box information)
______________________________________________________
_____
__________________________
____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
(Country – if not US)
REPORT
Page 1 of 2
Rev. 8/11/2010
Notice:
Causing this document to be delivered to the secretary of state for filing shall constitute the affirmation or
acknowledgment of each individual causing such delivery, under penalties of perjury, that the document is the
individual's act and deed, or that the individual in good faith believes the document is the act and deed of the
person on whose behalf the individual is causing the document to be delivered for filing, taken in conformity
with the requirements of part 3 of article 90 of title 7, C.R.S., the constituent documents, and the organic
statutes, and that the individual in good faith believes the facts stated in the document are true and the
document complies with the requirements of that Part, the constituent documents, and the organic statutes.
This perjury notice applies to each individual who causes this document to be delivered to the secretary of
state, whether or not such individual is named in the document as one who has caused it to be delivered.
7. Name(s) and address(es) of the
individual(s) causing the document
to be delivered for filing:
____________________ ______________ ______________ _____
(Last)
(First)
(Middle)
(Suffix)
______________________________________________________
(Street name and number or Post Office Box information)
______________________________________________________
____
__________________________
______________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
(Country – if not US)
(The document need not state the true name and address of more than one individual. However, if you wish to state the name and address
of any additional individuals causing the document to be delivered for filing, mark this box
and include an attachment stating the
name and address of such individuals.)
Disclaimer:
This form, and any related instructions, are not intended to provide legal, business or tax advice, and are
offered as a public service without representation or warranty. While this form is believed to satisfy minimum
legal requirements as of its revision date, compliance with applicable law, as the same may be amended from
time to time, remains the responsibility of the user of this form. Questions should be addressed to the user’s
attorney.
REPORT
Page 2 of 2
Rev. 8/11/2010
Page of 2