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Annual Report Extension Request

An Arizona-based corporation that was unable to file its Annual Report and Certificate of Disclosure within the allowed period must send an Annual Report Extension Request to the Arizona Corporation Commission.

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Read the Instructions 	C002i
but payment of the Annual Report fee must be delivered to the A.C.C. wit\
h the Extension Request 
or the extension will not be granted.	
Rev: 2010                              Page  of 1
C002.001
                     Arizona Corporation Commission – Corporations Di\
vision	
I ACCEPT	
Find the A.C.C. file number on the upper corner of filed documents OR on\
 our website at: 	http://www.azcc.gov/Divisions/Corporations	
By checking the box marked "I accept" below, I acknowledge under penalty of 
perjury  that this document together with any attachments is submitted in 
compliance with Arizona law.
SIGNATURE:
By the signature appearing below, the corporation certifies that it is u\
nable to file its  
annual report on or before the due date, and requests a  six (6) month extension  
of time  in which to file its annual report.
4.
ANNUAL REPORT FILING FEE  - this Extension Request form has no separate filing fee, 
3.
ANNUAL REPORT DUE DATE (mm/dd/yyyy) :
2.
A.C.C. FILE NUMBER:
1.
ENTITY NAME  -  give the exact name of the corporation as shown in A.C.C. records:	
Please be advised that A.C.C. forms reflect only the  minimum provisions required by statute.  You should seek private legal counsel \
for those matters that may pertain 
to the individual needs of your business.
All documents filed with the Arizona Corporation Commission are  public record and are open for public inspection. 
If you have questions after reading the Instructions, please call 602-54\
2-3026 or (within Arizona only) 800-345-5819. 
REQUIRED  - check only one:
Filing Fee:  None (regular processing)
Expedited processing – add $35.00 to filing fee. 
All fees are nonrefundable - see Instructions.       Mail:     Arizona Corporation Commission - Corporate Filings Section
            1300 W. Washington St., Phoenix, Arizona  85007
Fax:      602-542-4100I am a duly authorized 
bankruptcy trustee
, receiver, or 
other court-appointed fiduciary for 
the corporation filing this 
document.
I am the 
Chairman of the Board 
        of Directors  of the corporation 
        filing this document. I am a duly-authorized 
Officer of 
the corporation filing this document.  	
Date (mm/dd/yyyy)
  Printed Name
Signature                                      DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.	
ANNUAL REPORT EXTENSION REQUEST
Next: Affidavit of Pass Account Previous: ARTICLES OF INCORPORATION Domestic Business Corporation AS 10.06.205, .208, .210
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