Statement Of Amendment {UPA-1001(H)-1102(G)}

FORM Payment may be made by check payable to Secretary of State. If check is returned for any reason this filing will be void. 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 October 2014 UPA-Amendment (1001(h)/1102(g)) Illinois Uniform Partnership Act Statement of Amendment SUBMITINDUPLICATE Type or Print Clearly. $25 FILE #: This space for use by Secretary of State. Filing Fee: Approved: Federal Employer Identification Number (F.E.I.N.):____________________________________________________ 1. Partnership Name: ________________________________________________________________________ 2. State of Jurisdiction: ______________________________________________________________________________________________________ 3. The Statement of Qualification is amended as follows: (Check all applicable changes and specifiy them in item 4 below.) (For address changes -- P.O. Box alone is unacceptable.) o a) Change of registered agent and/or registered agent's office (give new name/address in item 4a) Must be an Illinois resident/company. o b) Change in address of chief executive office (give new address in item 4b) o c) Change in number of partners (give change of number of partners in item 4c) (Attach current list of partners.) (Total number of partners and number of Illinois partners.) o d) Change in Limited Liability Partnership name (give name change in item 4d) (Certified copy of Amendment From Domicile State required.) o e) Change in partner's name/address (give name/address change in item 4e) o f) Other (give information in item 4f) 4. List all changes from item 3. a) ____________________________________________________________________________________ b) ____________________________________________________________________________________ c) ____________________________________________________________________________________ d) ____________________________________________________________________________________ e) ____________________________________________________________________________________ f) ____________________________________________________________________________________ Printed by authority of the State of Illinois. November 2014 -- 1 -- UPA 14.4 American LegalNet, Inc. www.FormsWorkFlow.com UPA-1001(h)/1102(g) 5. Effective date of this amendment: Upon filing by the Secretary of State Deferred effective date (not to exceed 30 days after the file date): _______________________________ Month, Day, Year 6. The undersigned declares, 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 a partner. Day Month Year __________________________________________________ Signature ________________________________________________ Street Address 1. 1. __________________________________________________ Name (type or print) 2. 2. ________________________________________________ City, State, Zip __________________________________________________ Name if a Corporation or other Entity For additional space, continue in the same format on a plain white 8.5x11" sheet of paper. American LegalNet, Inc. www.FormsWorkFlow.com