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FORM UPA-1102
January 2008
Illinois Uniform Partnership Act
Statement of Foreign Qualification
Submit in duplicate. Please type or print clearly.
This space for use by Secretary of State.
Secretary of State Department of Business Services Limited Liability Division 501 S. Second St., Rm. 357 Springfield, IL 62756 217-785-8960 www.cyberdriveillinois.com
Payment must be made by certified check, cashier's check, money order, Illinois attorney's check or Illinois C.P.A.'s check. This space for use by Secretary of State. Date: Assigned File #: Filing Fee: $500 Approved:
Federal Employer Identification Number (F.E.I.N.) ________________________________________________________________
(Required to File)
1. Partnership Name: ________________________________________________________________________ 2. State of Jurisdiction: ______________________________________________________________________
(Name must end with "Registered Limited Liability Partnership," "Limited Liability Partnership," "R.L.L.P." or "L.L.P." or "RLLP" or "LLP.")
3. Address of Chief Executive Office: ______________________________________________________________________________________
Street Address (Must be a street address. P.O. Box alone is unacceptable.)
______________________________________________________________________________________
City, State, ZIP, County
4. If different from Address in #3, Street Address of an Office in this State, if any: ______________________________________________________________________________________ ______________________________________________________________________________________ 5. Registered Agent's Name and Registered Office Address: (must be an Illinois resident or company) Registered Agent: ________________________________________________________________________
First Name Middle Initial Last Name
Registered Office: ________________________________________________________________________
Number Street Suite #
________________________________________________________________________
City ZIP County
6. Brief Statement of the Business in which the Partnership Engages: ______________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________
Printed by authority of the State of Illinois. April 2008 - 200 - UPA 13.3
7. Total Number of Partners:
(Illinois Partners)
8. Names and Mailing Addresses of all Partners:
Name, Street Address, City, State, ZIP
Name, Street Address, City, State, ZIP
Name, Street Address, City, State, ZIP
9. The partnership hereby applies for foreign qualification status as a Limited Liability Partnership. 10. Registration application is effective on (check one): a) the filing date b) another date later than but not more than 60 days subsequent to the filing date:
Month, Day, Year
11. This application is accompanied by a Certificate of Good Standing (within the last 30 days), as well as a certified copy of the original LLP registration from the domicile state or country wherein the LLP is formed. 12. We declare, under the penalty of perjury, under the laws of the State of Illinois, that the foregoing is true, correct and complete. Executed on the
Day
of
Month
,
Year
by at least two partners.
Signature
Number, Street Address
Name and Title (type or print)
City, State, ZIP
Signature
Number, Street Address
Name and Title (type or print)
City, State, ZIP
Please submit this form in duplicate along with the $500 filing fee. Signatures must be in BLACK INK on an original document. For additional space, continue in the same format on a plain white 8.5x11" sheet of paper.
Printed by authority of the State of Illinois. April 2008 - 200 - UPA 13.3