MINNESOTA SECRETARY OF STATE 
           DOMESTIC COOPERATIVE PERIODIC REGISTRATION 
                                        Minnesota Statutes Chapter 308A/308B                For your convenience, this form 
                                                                                            has been designed to be 
                                        Must be filed by December 31                        completed online. You must have 
                                                                                            Acrobat Reader 5.0 or above to 
           File online at https://online.sos.state.mn.us/abr/corp_annual_filing.asp         use this new feature. Once your 
                                                                                            form is completed, be sure to 
                                                                                            select "Print" at the bottom of the 
           READ THE INSTRUCTIONS BEFORE COMPLETING THIS FORM                                screen to capture your data entry 
                                                                                            for printing. After printing, sign 
                                                                                            and send applicable fees as 
                                                                                            required.Note: Selecting "Reset" 
CURRENT INFORMATION ON FILE:                                                                will clear all data entry from this 
                                                                                            page. To print a blank form, go to 
                                                                                            File->Print.
1. File #: 
 
2. Cooperative Name: (Required) 
 
3. Registered Agent/ Registered Office Address: (Required) 
 
Street:____________________________________________________________________________________ 
                                        (PO Box is not acceptable) 
 
City:______________________________________________State:_____________________Zip:____________ 
 
Agents Name: (if applicable) 
 
4. Principal Place of Business Address: (Required) 
 
Address:_____________________________________________________________________________________ 
      (POBox isnotacceptable) 
 
City:______________________________________________State:_______________________Zip____________ 
 
5. Name and Business Address of C.E.O.: (Required) 
 
Name:_______________________________________________________________________________________ 
 
Address:____________________________________________________________________________________ 
 
City:_____________________________________________State:_______________________Zip____________ 
 
6. Does this cooperative own, lease, or have any financial interest in agricultural land or land capable of being 
farmed?     Yes______ No______ 
 
7. Name, daytime telephone number and e-mail address of contact person for the cooperative: 
 
Name: __________________________________________Phone(____)_________________ Ext. __________ 
 
E-Mail Address: ______________________________________________________________________________ 
 
NOTICE: Failure to file this form by December 31 of this year will result in the dissolution of this 
cooperative without further notice from the Secretary of State, pursuant to Minnesota Statutes, section 
308A.995, subdivision 4, paragraph (b). 
 
                                                           Print             Reset

                                INSTRUCTIONS FOR COMPLETING THIS FORM. 
 
All cooperative associations governed under Minnesota Statutes 308A/308B are required to file a periodic registration each 
odd numbered year. 
 
Items 2 and 3 are filed within the articles of incorporation; if there is a change to this information you must amend your 
articles of incorporation. The amendment form along with the $35.00 filing fee must be submitted at the same time as your 
periodic registration. You cannot use the periodic registration form to make changes to the articles of incorporation. 
 
Items 4 through 7 can be changed using the paper periodic registration form (in odd numbers years with our office). A 
cooperative that has been statutorily dissolved by our office may retroactively reinstate its existence by filing a single 
registration on paper and paying the $25.00 reinstatement fee. 
 
PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK. 
 
1. File Number: Provide the cooperative charter number issued by the Minnesota Secretary of State. 
 
2. Cooperative Name:  (Required) List the cooperative name on file with the Secretary of State's office. 
 
3. Registered Agent, if any and Registered Office Address:  (Required) If changes to the registered agent name or address 
are necessary an amendment form and $35 fee must be included with the periodic registration. 
 
4. Principal Place of Business Address: (Required) A full street address or rural route and rural route box number is 
required for filing the periodic registration. A post office box alone is not acceptable under the law.   
 
5. Name and Business Address of Chief Executive Officer: (Required) Fill in the name and complete business address of 
the Chief Executive Officer or other person who carries out the functions as C.E.O. of the corporation. 
 
6. Does the cooperative own, lease, or have any financial interest in agricultural land or land capable of being farmed? 
This question is optional. Check Yes or No. 
 
7.  Name, daytime telephone number and e-mail address of contact person for the cooperative:  This information is 
optional.  Please list a name, daytime telephone number and e-mail address of a person who can be contacted about this form. 
 
If this form is being mailed with an amendment form, please submit all items together and mail to the address below: 
 
                                            FILE IN-PERSON OR MAIL TO: 
                                        Minnesota Secretary of State - Renewals 
                                       Retirement Systems of Minnesota Building 
                                            60 Empire Drive, Suite 100 
                                                  St Paul, MN  55103 
                                (Staffed 8:00 - 4:00, Monday - Friday, excluding holidays) 
         
  File online at https://online.sos.state.mn.us/abr/corp_annual_filing.asp
                              
To obtain a copy of a form you can go to our web site at www.sos.state.mn.us , or contact us between 9:00am to 4:00pm, 
Monday through Friday at (651) 296-2803 or toll free 1-877-551-6SOS (6767). 
 
All of the information on this form is public.  Minnesota law requires certain information to be provided for this type of 
filing. If that information is not included, your document may be returned unfiled. This document can be made available in 
alternative formats, such as large print, Braille or audio tape, by calling (651)296-2803/voice. For a TTY/TTD (deaf and hard 
of hearing) communication, contact the Minnesota Relay Service at 1-800-627-3529 and ask them to place a call to (651)296-
2803. The Secretary of State's Office does not discriminate on the basis of race, creed, color, sex, sexual orientation, national 
origin, age, marital status, disability, religion, reliance on public assistance or political opinions or affiliations in employment 
or the provision of service. 
                                                                        
                          bus23 Domestic Cooperatice Periodic Reg. Rev. 5-07