State of Wisconsin                                                                   FILING FEE $40.00 
         DEPARTMENT OF FINANCIAL INSTITUTIONS                                                Please check box to request 
         Division of Corporate & Consumer Services                                            Optional Expedited Service        +   $25.00 
           
                                  AMENDMENT TO  
 FORM 604 
                           STATEMENT OF QUALIFICATION                                                                            
                         LIMITED LIABILITY PARTNERSHIP 
                                           Sec. 178.0901(6), Wis. Stats. 
 
1.  The limited liability partnership name (prior to any change effected by this amendment) is: 
 
                            (Enter limited liability partnership name, prior to any change) 
 
2.  Text of Amendment (Identify each item of the current statement of qualification that is being amended and 
how the amended item is to read. Attach additional pages if needed.) 
 
3.  This document must be signed by a person authorized by the partnership: 
 
         Signature                                                                                      Date 
 
            Printed Name                                                                               Title 
                            
This document was drafted by                                                                                                    
                                           (Name the individual who drafted the document) 
 
(Optional) This document has a delayed effective date/time of: ________________________________ 
                                                                                           (up to 90 days after received date) 
 
                                                                                              Office Use Only 
 
DFI/CORP/604 (R12/22)                                                                                                            1 
 

Contact Information: 
       
                                                    Name 

                                                  Mailing Address 

                City                                State             Zip Code 

                Email Address                                        Phone Number 

INSTRUCTIONS (Refer to section 178.0901(6), Wis. Stats., for document content) 
                                                             
Please use BLACK ink. Submit one original to State of WI-Dept. of Financial Institutions, Box 93348, Milwaukee WI, 
53293-0348, together with a check for the $40.00 filing fee, payable to the Department of Financial Institutions. (If sent 
by express or priority U.S. mail, please mail to State of WI-Dept. of Financial Institutions, Division of Corporate and 
Consumer Services, 4822 Madison Yards Way, 4th Fl., North Tower, Madison WI, 53705.) If requesting optional 
expedited service, please check the expedited service box in the upper-right corner of the first page and include an 
additional $25.00. Filing fees are non-refundable. This document can be made available in alternate formats upon request 
to qualifying individuals with disabilities. Upon filing, the information in this document becomes public and might be 
used for purposes other than those for which it was originally furnished. If you have any questions, please contact the 
Division of Corporate & Consumer Services at 608-261-7577 (hearing-impaired may call 711 for TTY) or by email at 
DFICorporations@dfi.wisconsin.gov. 
 
Item 1.  State the name of the limited liability partnership (before any change effected by this amendment). 
 
Item 2.  Specify the amendment(s) to the limited liability partnership’s statement of qualification by identifying each item 
that is being amended, and how the amended item is to read. 
 
Item 3.  The document must be executed by one or more persons authorized by the partnership. 
  
Drafter name.  If the document is executed in Wisconsin, section 182.01(3) of the Wisconsin Statutes requires that it 
include the name of the drafter.  If the document is not executed in Wisconsin, so indicate in the space provided for the 
drafter’s name. 
 
Optional delayed effective date/time.  This document may declare a delayed effective date and time.  The effective 
date/time may not be before, or more than 90 days after, the document is received by the Department of Financial 
Institutions for filing.  If no effective date/time is specified, the document will take effect at the close of business on the 
date it is received for filing by the Department. 
 
DFI/CORP/604 (R12/22)                                                                                            2