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FILING FEES 50. 00 if postmarked on or before November 15 2016 1709 N 19TH ST STE 3 BISMARCK ND 58501-2121 TYPE OR PRINT LEGIBLY SEE INSTRUCTIONS FOR FEE FILING AND MAILING INFORMATION. 2. DUE DATE The report is due on or before November 15 2016. 50. 00 if the report is postmarked on or before November 15 2016. Name Telephone Number Address Card Type Visa Account Number Signature required by credit card companies MasterCard Discover American Express CSC Number Card Expires MMYY Three-digit...
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