Arkansas Secretary                                                 of State                                                                            
                                                                              1401 W.Capitol,                                Suite 250, Little Rock, AR 72201
                                                                                                 501-682-3409 • www.sos.arkansas.gov
                              John Thurston                                   

                               STATEMENT OF QUALIFICATION OF 
                    FOREIGN LIMITED LIABILITY PARTNERSHIP 
                              (UNDER ACT 1518 of 1999 and Arkansas Code Annotated 4-46-1101)
                                   (PLEASE TYPE OR PRINT CLEARLY IN INK) 

1. The name of the Limited Liability Partnership is (name must end with “Registered Limited Liability Partnership”,
   “Limited Liability Partnership”, “R.L.L.P’, “L.L.P”, “FLLP”, or “LLP”.) :

   ___________________________________________________________________________________________________

   Fictitious name to be used in Arkansas: ___________________________________________________________________
   (The partnership may use a fictitious name to transact business in Arkansas, if its real name is unavailable, and it delivers to the Secretary
   of State a copy of the resolution of its board of directors, certified by its secretary, adopting a fictitious name.)

2. State of Origination: ______________________________

3. Street address of the partnership's chief executive office is: ___________________________________________________

   ___________________________________________________________________________________________________
   Street Address                                                      City                                          State                                                      ZIP 
4. Street address in Arkansas if different from the chief executive office: __________________________________________

   __________________________________________________________________________________________________
   Street Address                  City                                            State                                                                ZIP
5. The name and address of the agent for service of process in the State of Arkansas is: ______________________________
                                                                                                                           Name

   __________________________________________________________________________________________________Arkansas
   Street Address                  City                                                                                                                 ZIP

6. Deferred effective date, if any: _________________________________________________________________________________

   I, hereby, state that the above-listed limited liability partnership is a registered limited liability partnership and satisfies the
   requirements of the state or other jurisdiction under whose laws it is formed.

   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.

   Executed this ____________________ day of _______________________, _______________.

   _________________________________________                                  __________________________________________
   Partner (Typed or Printed)                                                 Partner (Signature)

$300.00 Filing Fee payable to Arkansas Secretary of State                                                                                               Rev. 9/20

                 Arkansas Secretary                                          of State          
                                                                  1401 W. Capitol, Suite 250, Little Rock, 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) 

                                                                                                                 Rev.9/20