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. If there is no office in Arkansas, the name and street address of the agent for service of process for the limited liability

partnership who is also an Arkansas resident or has authority to do business in Arkansas is: ____________________

_____________________________________________________________________________________________

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. 11/18

                 ArkansasSecretaryof                                           
                                                               State Capitol • Little Rock, Arkansas 72201-1094
                                                                             501-682-3409 • www.sos.arkansas.gov
                 John Thurston

                 Business&CommercialServices,250VictoryBuilding,1401W.Capitol,LittleRock                         

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

                                         JURISDICTION (SELECT ONE) 
                                         □ DOMESTIC    □FOREIGN

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

                                              st
NOTE: Annual Reports will be due on or before April 1  the year following filing or qualification in this state.

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_____________,__________________. 

_____________________________________________________  __________________________________________________ 
Signature                                              Authorized Officer (Type or Print) 

                                                                                                                 Rev. 11/18