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                                                                                                                    SECRETARY OF STATE 
                INDIANA BUSINESS ENTITY REPORT                                                                      BUSINESS SERVICES DIVISION 
                State Form 48725 (R16 / 6-19)                                                              302 West Washington Street, Room E018 
                                                                                                                    Indianapolis, IN 46204 
                                                                                                                    Telephone: (317) 232-6576 
                                                                                                                        www.sos.in.gov  
INSTRUCTIONS:  1. All corporations must complete Articles I through VI and Article VIII. 
                      2. All LLCs, Master LLCs, LLPs, and LPs must complete Articles I through V and Article VIII.  
                         Series do not file Business Entity Reports. 
    3. Please   or          TYPE     PRINT in INK.  
                      4. Make check or money order payable to the Secretary of State.  
                      5. Submit original completed paperwork and payment to: 302 West Washington Street, Room E-018, Indianapolis, IN 46204. 
                      6. File report online with a credit card.  Refer to www.sos.in.gov. 
 
REQUIREMENTS:  Professional Corporations must complete the professional license information below. 
 
                INFORMATION CONTAINED ON THIS PAGE IS NOT PART OF THE PUBLIC RECORD. 
 
Name    of business 
      
E-mail  address of business (SOS use only) 
      
RETURN DOCUMENTS TO: 
 
 Name 
      
Street  address, line 1 
      
Street  address, line 2 
      
 City                                                                      State                                    ZIP code 
                                                                                                                          
Telephone   number                                 E-mail address (If different from above – SOS use only) 
(     )                                                  
 
                                                  FOR PROFESSIONAL CORPORATIONS ONLY 
Please complete the following section so the Indiana Secretary of State can verify licensing information. 
Information for only one shareholder is required. 
                   Name                                              Address                     Profession         Indiana License        Status 
                                              (number and street, city, state, and ZIP code)                             Number 

                                                                                                                                        Shareholder 

                                                                                                                                        Shareholder 

                                                                                                                                        Shareholder 

                                                                                                                                        Shareholder 

                                                                                                                                        Shareholder 
 

              INDIANA BUSINESS ENTITY REPORT 
              State Form 48725 (R16 / 6-19) 
              
INSTRUCTIONS: 
1.  Domestic and Foreign For Profits, Limited Liability Companies (LLC), Limited Liability Partnerships (LLP), and Limited Partnerships (LP) pay a $50 
    fee and file a report every other year (biennially). 
2.  Domestic and Foreign Nonprofit Corporations pay a $20 fee and file a report every other year (biennially).  
3.  Series do not file a report. 
 
Please visit INBIZ.in.gov to determine when your report is due. Biennial reports are due every other year in the anniversary month of the business forming. 
 
                                                             ARTICLE I – ENTITY INFORMATION 
Current entity name * 
      
Current principal office address (number and street, city, state, and ZIP code) 
      
* Entity name cannot be changed on this report. 
 
                                                             ARTICLE II – FILING YEAR 
Current filing year                                 Past filing years reported on this form 
                                                          
                                                             ARTICLE III – FORMATION INFORMATION 
Date of formation / registration (month, day, year) Jurisdiction of formation  
                                                          
                                                             ARTICLE IV – ENTITY TYPE 
Please check the appropriate type for your corporate entity. 
    Business Corporation          Professional Corporation                       Nonprofit Corporation   Ag Coop           Limited Liability Company (LLC)     
    Master LLC                    Limited Partnership (LP)                       Limited Liability Partnership (LLP) 
 
                                                    ARTICLE V – REGISTERED AGENT INFORMATION 
To determine if your Registered Agent is a Commercial Registered Agent (CRA), go to INBIZ.in.gov.  
Provide either commercial registered agent or noncommercial registered agent information below. 
                                     Name of registered agent (Do not provide address.) 
    Commercial registered agent            
OR 
                                     Name of registered agent 
    Noncommercial registered agent         
Address (number and street) (A P.O. Box is not acceptable unless accompanied by a Rural Route number.)  City               State ZIP code 
                                                                                                                           IN          
(OPTIONAL) E-mail address of the registered agent at which the registered agent will accept electronic service of process 
      
     By checking the box, the Signator(s) represent(s) that the Registered Agent named in this Indiana Business Entity Report has consented to the  
    appointment of Registered Agent. 
 
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This section is REQUIRED      for Corporations and Nonprofit Corporations. 
This section is optional for Limited Liability Companies, Limited Liability Partnerships, and Limited Partnerships. 
                             ARTICLE VI – GOVERNING PERSON INFORMATION (Officers, Directors, Principals, etc.) 
   By checking the box, I acknowledge that the governing person information has NOT changed. 
 If you check this box, please do not enter any information in the below fields. 
Please indicate whether the name should be added, edited, or removed from the record. You must have at least one governing person on the record. 
Name                                                  Title (i.e. president, secretary, member, manager, partner)   Action (Check one.) 
                                                                                                                         Add      Edit      Remove 
Address (number and street)                           City                                                          State               ZIP code 
                                                                                                                                              
Name                                                  Title (i.e. president, secretary, member, manager, partner)   Action (Check one.) 
                                                                                                                         Add      Edit      Remove 
Address (number and street)                           City                                                          State               ZIP code 
                                                                                                                                              
Name                                                  Title (i.e. president, secretary, member, manager, partner)   Action (Check one.) 
                                                                                                                         Add      Edit      Remove 
Address (number and street)                           City                                                          State               ZIP code 
                                                                                                                                              
Name                                                  Title (i.e. president, secretary, member, manager, partner)   Action (Check one.) 
                                                                                                                         Add      Edit      Remove 
Address (number and street)                           City                                                          State               ZIP code 
                                                                                                                                              
                                                      ARTICLE VIII – SIGNATURE  
This section must be signed by a corporate officer, chairman of the board, registered agent, certified public accountant or an attorney 
employed by the entity or by a member or manager of the LLC. 
In Witness Whereof, the undersigned executes this Indiana Business Entity Report and verifies, subject to penalties of  
 
perjury, that the statements contained herein are true, this ______ day of ________________________, 20______. 
Signature                                                                  Printed name 
                                                                                 
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