Annual Report {LP 210}

Form LP 210 August 2012 Secretary of State Department of Business Services Limited Liability Division 501 S. Second St., Rm. 357 Springfield, IL 62756 217-524-8008 www.cyberdriveillinois.com Payment may be made by check payable to Secretary of State. If check is returned for any reason this filing will be void. Please do not send cash. Illinois Uniform Limited Partnership Act FILE # FILE Prior to: This space for use by Secretary of State. Annual Report Please type or print clearly. Filing Fee: $100 Approved: Do not make changes on this form. To change the Agent and/or Designated Office, submit Form LP 115 along with the $50 filing fee. For all other changes, submit LP 202 (Illinois) or LP 902.5 (foreign) along with the $50 filing fee. 1. Limited Partnership Name: __________________________________________________________________ 2. Address of Office at which records required by Section 111 (Illinois) or Section 902 (Foreign) are kept: ________________________________________________________________________________________ Street Address (P.O. Box alone is unacceptable.) ________________________________________________________________________________________ City, State, ZIP 3. 4. Foreign Alternate Name, if any: ____________________________________________________________ Registered Agent: ______________________________________________________________________ Name Registered Office:______________________________________________________________________ Street Address (P.O. Box alone is unacceptable.) IL ____________________________________________________________________________________ City ZIP 5. State or Jurisdiction of Organization: ________________________________________________________ The Annual Report must be signed by a General Partner. I affirm that any entity serving as a General Partner for this Limited Partnership is in good standing in its home state. The undersigned affirms, under penalties of perjury, that the facts stated herein are true, correct and complete. Date: ____________________________________ Month, Day, Year __________________________________________ General Partner Name if a corporation or other entity ________________________________________ Signature __________________________________________ Name and Title (type or print) Date: ____________________________________ Month, Day, Year __________________________________________ General Partner Name if a corporation or other entity (must be in good standing) Signatures must be in black ink on an original document. Printed on recycled paper. Printed by authority of the State of Illinois. August 2012 -- 1 -- CLP 12.15 American LegalNet, Inc. www.FormsWorkFlow.com