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FORM UPA-1102                                                Illinois  
                                                                                                                                                                                                                                                      This space for use by Secretary of State.
October 2020                                          Uniform Partnership Act 
Secretary of State   
Department of Business Services            Statement of Foreign Qualification
Limited Liability Division 
501 S. Second St., Rm. 351                            SUBMITINDUPLICATE   
Springfield, IL  62756                                  Type or print clearly. 
217-524-8008 
www.cyberdriveillinois.com                  
Payment must be made by certified         Filing Fee:   $500 
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 (FEIN): ________________________________________________________________ 
                                                                                                                                                                                (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.   State of jurisdiction:______________________________________________________________________ 

3.   Address of Chief Executive Office: 

      ______________________________________________________________________________________ 
                                                                                Street Address (Must be a street address. P.O. box alone is unacceptable.) 

      ______________________________________________________________________________________ 
                                                                                                                            City, State, ZIP 

4.   If different from address in #3, street address of an office in this state, if any: 

      ______________________________________________________________________________________ 

      ______________________________________________________________________________________ 

5.   Registered agent’s name and registered office address (must be an Illinois resident or company): 

     Registered agent: ________________________________________________________________________ 
                                           First Name                  Middle Initial                                                                                                                                                                               Last Name
     Registered office: ________________________________________________________________________ 
                                           Number                                                                                            Street                                                                                                                             Suite #
                                 ________________________________________________________________________IL
                                           City                                                                                                                                                                                                                                 ZIP

6.   Brief statement of the business in which the partnership engages:  ______________________________________ 

       __________________________________________________________________________________________ 

       __________________________________________________________________________________________

                                       Printed by authority of the State of Illinois. November 2020 – 1 – UPA 13.10

UPA-1102

7.   Total number of partners: 
 
8.   The partnership hereby applies for foreign qualification 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.This application is accompanied by a Certificate of Good Standing (within the last 30 days) from the 
    domicile state or country wherein the LLP is formed. 
 
11. 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 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
 
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