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

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