Mark Martin, Arkansas Secretary of State LIMITED LIABILITY PARTNERSHIP ANNUAL REPORT 2014 Report Due April 1 (PLEASE TYPE OR PRINT CLEARLY IN BLACK INK) The undersigned, pursuant to A.C.A. § 4-46-1003, sets forth the following: Domestic 1. Name of the Limited Liability Partnership: 2. State or jurisdiction under whose laws Limited Liability Partnership is formed: 3. Street Address (Chief Executive Office): City: Email Address: 4. Street Address (Office in Arkansas, if different than above): City: 5. Agent for Service of Process: Street Address: City: Mailing Address (if different than above): City: 6. Tax Contact Name: Mailing Address: City: 7. Statement of Qualification Date: 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. State: Zip: State: Zip: State: Zip: State: Zip: State: Zip: Foreign Executed this ______________ day of _________________________, _____________ (Day) (Month) (Year) Authorizing Officer (Type or Print in Black Ink) Signature of Authorizing Officer (Sign in Black Ink) Please verify that the address information on the reverse side is correct. If it is not correct, please indicate changes in the space provided below. Business and Commercial Services Division 1401 W. Capitol, Suite 250, Little Rock, Arkansas 72201-1094 Make checks payable to Arkansas Secretary of State Phone: 501-682-3409 or Toll Free: 888-233-0325 Email: arsos@sos.arkansas.gov · Website: www.sos.arkansas.gov Filing Fee: $15.00 ­ Remittance must accompany this report. Rev. 11/13 American LegalNet, Inc. www.FormsWorkFlow.com