Preparer of Annual Report

I am filling a late annual report and personal property return to get my business back in good standing. At the bottom next to where i sign, it asks for the name of a firm as well as a signature of a preparer of the report. I did not use a firm to fill this document out, and was wondering, do I have to have this signature at the bottom? What would happen if I left that blank? how would I signify that I am not using one and thus cannot get a signature there?

This is a copy of the document without any info on it http://ift.tt/2fkGMBX

Thank You Very Much!