Beneficial Ownership Information Report

* Type of filing:

Initial report

Correct prior report

Update prior report

Newly exempt entity

Approval Official Signature Date

Request to receive FinCEN ID

Legal name and alternate name(s)

* Full Association Name

Alternate name (e.g., trade name, DBA)

Form of identification

* Tax Identification type

* Tax Identification number

Jurisdiction of formation or first registration

* Country/Jurisdiction of formation

Current U.S. address

* Address (number, street, and apt. or suite no.)

* City

* State

* ZIP code

Association was created prior to January 1, 2024 (Uncheck Box if Association is new and was created after January 1, 2024.)

Company Applicant - FinCEN ID

FinCEN ID (first time filers, leave blank, not required)

Legal name and date of birth

* Individual's last name

* First name

Middle name

Suffix

* Date of birth of Person Filling Out This Form

* Address (number, street, and apt. or suite no.)

* City

* Country/Jurisdiction

* State

* ZIP/Foreign postal code

Form of identification and issuing jurisdiction

* Identifying document type

* Identifying document number

* Country

* State

* Upload Identifying document image

Drag file here or choose from folder

Note: Document uploaded cannot exceed 4MB in size.

Please choose total number of board members and ensure all sections/fields are completed before moving to the next page.

Board Member FinCEN ID

FinCEN ID

Legal name and date of birth

* Individual's last name

* First name

Middle name

Suffix

* Date of birth

Residential address

* Address (number, street, and apt. or suite no.)

* City

* Country/Jurisdiction

* State

* ZIP/Foreign postal code

Form of identification and issuing jurisdiction

* Identifying document type

* Identifying document number

* Country

* State

* Upload Identifying document image

Drag file here or choose from folder

Note: Document uploaded cannot exceed 4MB in size.

* By submitting, I certify that I am authorized to file this BOIR on behalf of the reporting company. I further certify, on behalf of the reporting company, that the information contained in this BOIR is true, correct, and complete.

* Submitter Email

* Confirm Submitter Email

* Submitter First Name

* Submitter Last Name

COMPLIANCE REMINDER: The willful failure to report complete beneficial ownership information to FinCEN, the willful failure to update beneficial ownership information provided to FinCEN when previously reported information changes, or the willful provision of false or fraudulent beneficial ownership information to FinCEN, may result in civil or criminal penalties. A person may also be subject to civil or criminal penalties for willfully causing a reporting company to report incomplete or false beneficial ownership information to FinCEN.

Submission Processing...

Submission Status Confirmation

SUBMISSION INFORMATION

Submission Status Confirmation

SUBMISSION INFORMATION

SUBMITTER INFORMATION

Beneficial Ownership Information Report

Company associated with latest report (not applicable for initial report)

Legal name and alternate name(s)

Form of identification

Jurisdiction of formation or first registration

Current U.S. address

Submission Processing...

Submission Status Confirmation

SUBMISSION INFORMATION

Submission Status Confirmation

SUBMISSION INFORMATION

SUBMITTER INFORMATION

Beneficial Ownership Information Report

Company associated with latest report (not applicable for initial report)

Legal name and alternate name(s)

Form of identification

Jurisdiction of formation or first registration

Current U.S. address

Company Applicant

Board Member #1