If you prefer to submit this form in paper via fax or mail, use the PDF form:
Amount of Paid-in-Capital: The amount paid by the shareholder.
Date: The date the transaction occurred. Date must include the month, day and year.
Name and Address of Shareholder: The name and residence or mailing address of each shareholder, including city, state and zip code.
Occupation of Shareholder: The occupation of the shareholder is the nature of the individual’s primary job. If the shareholder is self-employed, the nature of the business must be provided. If the shareholder is not employed such as a student, retired, or a volunteer, indicate “not employed.”