NEVADA ANNUAL STATEMENT
PUBLICATION FORM

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PAYPAL is the PROCESSING company.
They accept Debit, Visa, MasterCard, Discover or American Express cards.
You DO NOT need to have a PayPal account.


Note: We do not send separate confirmation of receipt of your order.
Your receipt from PayPal is confirmation that we received your order.
(PayPal can take up to 12 hours to forward your order & payment notification to us.)

         
        Please enter all information in the appropriate boxes below.  
         
        Note: Annual Statements must be published each calendar year. 
        Please tell us the calendar year in which you would like your Statement published. 
           
        Statement to be published during:       2021
        Company Name .............................
        Company Officer Name ................
        ONE TITLE of Company Officer ......
        Company Principal Address ........
        Principal Address City State Zip .
        NEVADA REGISTERED AGENT Address ....
        NEVADA REGISTERED AGENT City State Zip ..


        Upon publication a Certification of Publication will be sent to you by first class mail.
        Copies of Certification of Publication may be purchased for an additional $5.00 each and will be emailed to the Contact Email on record.

        Please tell us where to send the Certification.
        (The following information is not published.)
        Contact Name ................................
        Contact Company Name ..............
        Contact Address ...........................
        Contact City State Zip ..................
        Contact Telephone .......................
        Contact Email ...............................

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