Mark Martin, Arkansas Secretary of State LIMITED LIABILITY PARTNERSHIP ANNUAL REPORT 2015 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 Foreign 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: 4. Street Address (Office in Arkansas, if different from above): City: State: Zip: 5. Agent for Service of Process (If no office in Arkansas.): State: Zip: Street Address: City: 6. Tax Contact Name: State: Zip: Mailing Address: City: 7. Statement of Qualification Date: 8. List of Partners: State: Zip: General Partner/ Partner: General Partner/Partner: General Partner/ Partner: Tax Preparer: Executed this ______________ day of _________________________, _____________ (Day) (Month) (Year) Authorizing Officer (Type or Print in Black Ink) Signature of Authorizing Officer (Sign in Black Ink) 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. American LegalNet, Inc. www.FormsWorkFlow.com Rev. 07/15