Form 05-102-A — Texas Franchise Tax Public Information Report (Annual)

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Taxpayer number Report year Due date Tcode Mailing address Taxpayer name City Blacken circle if the mailing address has changed. State ZIP code plus 4 Blacken circle if there are currently no changes from previous year; if no information is displayed, complete the applicable information in Sections A, B and C. Principal place of business Name m m d d y y Term expiration Title Director YES City Mailing address Name m m d d y y Term expiration Title Director YES City Mailing address Name m m d d y y Term expiration Title Director YES City Mailing address State ZIP Code State ZIP Code State ZIP Code Percentage of ownership State of formation Percentage of ownership State of formation Percentage of ownership State of formation City State ZIP Code (see instructions if you need to make changes) Agent: Date Area code and phone number ( ) - Title VE/DE PIR IND PM Date Texas Franchise Tax Public Information Report Professional Associations (PA) and Financial Institutions. You have certain rights under Chapter 552 and 559, Government Code, to review, request and correct information we have on file about you. This report must be signed to satisfy franchise tax requirements. Mail signed report to: Texas Comptroller of Public Accounts P.O. Box 149348 Austin, Tx 78714-9348 For locations and phone numbers visit www.comptroller.texas.gov/about/contact.SECTION A SECTION B 0 percent or more. SECTION C ore in this entity. sheets for Sections A, B and C, if necessary. The information will be available for public inspection. I declare that the information in this document and any attachments is true and correct to the best of my knowledge and belief, as of the date below, and that a copy of this report has