ArkansasSecretaryofState                                                                                     
                                                                                  StateCapitol•LittleRock,Arkansas72201-1094       
                                                                                         501-682-3409 • www.sos.arkansas.gov
                 John Thurston
                                                                                                                              
                 Business&CommercialServices,250VictoryBuilding,1401W.Capitol,LittleRock                          

       APPLICATION FOR QUALIFICATION OF LIMITED LIABILITY 
                                                         PARTNERSHIP 
                                                         (Under Act 1518 of 1999) 
                                          (PLEASE TYPE OR PRINT CLEARLY IN INK) 

1. The name of the limited liability partnership is: ________________________________________________________

2a. The street address of the chief executive office of the limited liability partnership is: ___________________________ 

    _____________________________________________________________________________________________ 

2b. The street address of an office in Arkansas, if different from the chief executive office: _________________________ 

    _____________________________________________________________________________________________ 

3. The name and street address of the agent for service of process for the limited liabilitypartnership shall be:

    _____________________________________________________________________________________________Agent Name

    ________________________________________________________ _________________ Arkansas ___________Zip
                           Street Address                                                City
4.  Statement of intent to be a limited liability partnership: __________________________________________________

    _____________________________________________________________________________________________

5.  Deferred effective date, if any: _____________________________________________________________________

I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class 
C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days. 

Authorizing Officers ________________________________________________________________________________ 
                                                          (Type or Print) 

Authorized Signature ____________________________________                         ______________________________________ 
                 (Partner)                                                        (Date) 

Authorized Signature ____________________________________                         ______________________________________ 
                 (Partner)                                                        (Date) 

$50.00 Filing Fee payable to Arkansas Secretary of State                                                 Rev. 9/20

                    ArkansasSecretaryofState                                                           
                                                                  1401W.Capitol,           Suite 250, LittleRock , AR 72201
                    John Thurston                                                  501-682-3409 • www.sos.arkansas.gov

                                Annual Report – Contact Information
                                         PLEASE TYPE OR PRINT CLEARLY IN INK 

                                         JURISDICTION (SELECT ONE) 

                                                       DOMESTIC FOREIGN 

                                                 ENTITY TYPE (SELECT ONE)
                                    LIMITED PARTNERSHIP- Due May 1
                                    LIMITED LIABILITY PARTNERSHIP- Due April 1       
                                    LIMITED LIABILITY LIMITED PARTNERSHIP- Due May 1

In order for this entity to receive its annual reporting form, please complete and file with the Office of the Secretary of 
State at the time of filing. 

________________________________________________ _____________________________________________ 
Entity name as used in Arkansas                                 Contact Person 

________________________________________________ _____________________________________________ 
Street Address or Post Office Box Number                        City, State & Zip 

________________________________________________ _____________________________________________ 
Telephone Number                                                E-mail Address

NOTE: Annual Reports will be due the year following filing or qualification in this state.

The information provided herein is true to the best of my knowledge and is made with the intent to file with the 
Arkansas Secretary of State. I understand that the statements made herein are under oath, and that 
knowingly making a false statement herein is a Class C felony (A.C.A § 5-53-102) or a Class A misdemeanor 
(A.C.A. § 5-53-103), or both.

Executed this ___________ day of _____________, __________________. 

Signature                                                       Authorized Officer (Type or Print) 

 $50.00 Filling Fee payable to Arkasas Secretary of State                                                        Rev.9/20