Statement Of Qualification (LLP) {UPA-1001}

DO NOT STAPLE FORM UPA-1001 January 2008 Illinois Uniform Partnership Act Statement of Qualification Submit in duplicate. Please type or print clearly. This space for use by Secretary of State. Secretary of State Department of Business Services Limited Liability Division 501 S. Second St., Rm. 357 Springfield, IL 62756 217-785-8960 www.cyberdriveillinois.com Payment must be made by certified check, cashier's check, money order, Illinois attorney's check or Illinois C.P.A.'s check. This space for use by Secretary of State. Date: Assigned File #: Filing Fee: $ Approved: Federal Employer Identification Number (F.E.I.N.) __________________________________________________ (Required to File) 1. Partnership Name: ________________________________________________________________________ (Name must end with "Registered Limited Liability Partnership," "Limited Liability Partnership," "R.L.L.P.," "L.L.P." or "RLLP.," "LLP") 2. Address of Partnership's Chief Executive Office: ________________________________________________ ______________________________________________________________________________________ Street Address (Must be a street address. P.O. Box alone is unacceptable.) ______________________________________________________________________________________ City, State, ZIP, County 3. If different from address in number 2, the street address of an office in this state, if any: ______________________________________________________________________________________ ______________________________________________________________________________________ 4. Registered Agent's Name and Office Address: (Must be an Illinois resident or company.) Registered Agent: ________________________________________________________________________ First Name Middle Initial Last Name Registered Office: ________________________________________________________________________ Street Address City/ZIP County 5. Filing Fees: Filing fee per partner: $100 Number of partners: Total filing fee: $ Fees: $100 for each partner, but not less than $200 or more than $5,000. (Minimum of two partners.) Printed by authority of the State of Illinois. March 2008 ­ 200 ­ UPA 12.3 American LegalNet, Inc. www.FormsWorkflow.com 6. Total Number of Partners: 7. Names and Mailing Addresses of all Partners: Name, Street Address, City, State, ZIP (Illinois Partners) Name, Street Address, City, State, ZIP Name, Street Address, City, State, ZIP 8. Brief statement of the business in which the partnership engages: 9. The Partnership hereby applies for status as a Limited Liability Partnership. 10. Registration Application is effective on (check one): a) the filing date b) another date later than but not more than 60 days subsequent to the filing date: Month, Day, Year 11. We declare, under the penalty of perjury, under the laws of the State of Illinois, that the foregoing is true, correct and complete. Executed on the ___________of _______________ , ___________ by at least two partners. Day Month Year Signature Number, Street Address Name and Title (type or print) City, State, ZIP Signature Number, Street Address Name and Title (type or print) City, State, ZIP Please submit this form in duplicate along with $100 for each partner, but not less than $200 or more than $5,000, minimum two partners. Signatures must be in BLACK INK on an original document. Carbon copy, photocopy or rubber stamp signatures my only be used on conformed copy. For additional space, continue in the same format on a plain white 8.5x11" sheet of paper. Printed by authority of the State of Illinois. March 2008 ­ 200 ­ UPA 12.3 American LegalNet, Inc. www.FormsWorkflow.com