Arkansas Secre t a ry of State Charlie Daniels State Capitol • Little Rock, Arkansas 72201-1094 501-682-3409 • www.sos.arkansas.gov Limited Liability Company Franchise Tax Please Type or Print In order for this limited liability company to receive its annual franchise tax reporting form, please complete and file with the Office of the Secretary of State at the time of filing. _________________________________ Limited Liability Company name as used in Arkansas _________________________________ Street address or Post Office Box number _________________________________ Telephone number __________________________ Contact person __________________________ City, State, ZIP __________________________ E-mail address NOTE: This tax is due on or before May 1 of the year following filing or qualification in this state. _________________________________ Signature __________________________ Title Rev. 4/06 American LegalNet, Inc. www.FormsWorkflow.com