DO NOT STAPLE Print Reset FORM Illinois Uniform Partnership Act File #: UPA-1003-(D) Renewal Statement of Domestic October 2009 Limited Liability Partnership This space for use by Payment may be made by check Secretary of State. Secretary of State payable to Secretary of State. Department of Business Services Limited Liability Division 501 S. Second St., Rm. 357 This space for use by Secretary of State. Springfield, IL 62756 217-785-8960 Date: www.cyberdriveillinois.com Filing Fee: Approved: THIS RENEWAL STATEMENT IS EFFECTIVE FOR ONE YEAR. LLP STATUS WILL EXPIRE IF THIS STATEMENT IS NOT FILED WITHIN 60 DAYS PRIOR TO THE ANNIVERSARY DATE OF THE ORIGINAL REGISTRATION WITH THE SECRETARY OF STATE. DO NOT MAKE CHANGES ON THIS FORM. IF CHANGES ARE NECESSARY, AMENDMENT FORM UPA-1001(h)/1102(g) AND THE $25 FEE IS REQUIRED. 1. Registered Limited Liability Partnership Name:__________________________________________________ ______________________________________________________________________________________ 2. Federal Employer Identification Number (FEIN): __________________________________________________ 3. Effective Date of Initial Registration: _________________________________________________________ 4. Address of Chief Executive Office (P.O. Box alone and c/o are unacceptable.):__________________________ ______________________________________________________________________________________ 5. Illinois Registered Agent: __________________________________________________________________ Illinois Registered Office (P.O. Box alone and c/o are unacceptable.): ________________________________ ______________________________________________________________________________________ 6. Total Number of Partners (minimum of 2): ________________________________________________________ Fee Per Partner (x $100) (minimum of $200):____________________________________________________ Total Filing Fee (In no event shall the fee exceed $5,000.): ________________________________________ ♻ Printed on recycled paper. Printed by authority of the State of Illinois. November 2009 — 200 — RLLP 2.10 |
UPA-1003-(D) 7. Brief statement of the business in which the partnership engages: 8. The partnership hereby applies for continual status as a registered Limited Liability Partnership. 9. The undersigned affirms, under penalties of perjury, having authority to sign hereto, that this renewal application is to the best of my knowledge and belief, true, correct and complete. Dated 20 Month, Day Year Signature Street Address Name and Title (type or print) City/Town Partner Name if a Corporation or other Entity State, ZIP ♻ Printed on recycled paper. Printed by authority of the State of Illinois. November 2009 — 200 — RLLP 2.10 |