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                                                                                                                      FILE #
FORM   UPA-1001                                               Illinois 
                                                                                                                      This space for use by Secretary of State.
September 2019                                       Uniform Partnership Act
Secretary of State  
Department of Business Services             Statement of Qualification
Limited Liability Division
501 S. Second St., Rm. 351                             SUBMIT IN DUPLICATE
Springfield, IL  62756                                      Type or Print Clearly.
217-524-8008
www.ilsos.gov
Payment must be made by certified             Filing Fee:   $ 
check, cashier’s check, money order,          Approved:
Illinois attorney’s check or Illinois
C.P.A.’s check. If a check is returned for
any reason, this filing will be void.

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

3. If different from address in number 2, the street address of an office in this state, if any:

    ______________________________________________________________________________________

    ______________________________________________________________________________________

4. Registered agent name and office address: (Must be an Illinois resident or company.)

    Registered agent: ________________________________________________________________________
                                          First name                          Middle initial                                Last name
    Registered office: ________________________________________________________________________IL
                                     Street address                               City                                      ZIP

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. September 2019 – 1 – UPA 12.6

UPA-1001

6.   Total number of partners:

7.   Brief statement of the business in which the partnership engages:

8.   The partnership hereby applies for status as a Limited Liability Partnership.

9.   Registration application is effective on (check one):
        oa) the filing date
        ob) another date later than but not more than 30 days subsequent to the filing date:
                                                                                                  Month, Day, Year
10. The undersigned declares, under penalty of perjury, and 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                                              Street address

                    Name and title (type or print)                                City, State, ZIP

                           Signature                                              Street address

                    Name and Title (type or print)                                City, State, ZIP

                If additional space is required, please continue in the same format 
                                     on a plain white 8.5x11” sheet of paper.