Free Statement of Qualification for Conversion - Arizona

Ken Bennett Secretary of State Limited Partnerships 1700 West Washington 7th Fl Phoenix, Arizona 85007 Make Check Payable to: Secretary of State Fee: $3.00 Plus $10.00 Authority to Transact Business as an LP Plus $3.00 per page PLEASE SUBMIT IN DUPLICATE with a self-addressed, stamped envelope.

Secretary of State Use:

All correspondence regarding this filing will be sent to the statutory agent. STATEMENT OF QUALIFICATION FOR CONVERSION OF LIMITED PARTNERSHIP OR LIMITED LIABILITY PARTNERSHIP TO A LIMITED LIABILITY LIMITED PARTNERSHIP A.R.S. 29-308 To be filed by a limited/ limited liability partnership not on record with the Secretary of State

_____________________________________________________________________________________________ Name of the General/Limited/ Limited Liability Partnership

The state and date of formation

Authorizing agency (optional)

Registration number(optional)

Name of limited liability limited partnership (end with "Limited Liability Limited Partnership" or "LLLP"

Street address of chief executive office in Arizona (PO Box and c/o are not acceptable)

City

Zip

Name of the service of process agent

Phone

Arizona address of agent (PO Box and C/O are not acceptable) Statement of status for which this application is made: _______LLLP Signature of general partners:

City

Arizona

Zip

Signature

Print Name

Date

Signature

Print Name

Date

Delayed effective date if any: ___________________________ ****An affidavit evidencing publication shall be filed with the Secretary of State within ninety days after the filing of the statement of qualification. (Filing Fee $3) 28