Filing Fee: $15.00 Remittance must accompany this report. Rev. , Arkansas Secretary of State LIMITED LIABILITY PARTNERSHIPANNUAL REPORT 201Report Due April 1 (PLEASE TYPE OR PRINT CLEARLY IN BLACK INK)The undersigned, pursuant to A.C.A. 247 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: State: Zip: Email Address: 4.Street Address (Office in Arkansas, if different than above ): City: State: Zip: 5 .Agent for Service of Process: Street Address: City: State: Zip: Mailing Address ( if different than above) : City: State: Zip: 6 . Tax Contact Name: Mailing Address : City: State: Zip: 7 . Statement of Qualification Date: Executed this day of , (Day) (Month) (Year) Authorizing Officer Signature of Authorizing Officer (Type or Print in Black Ink) (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 . American LegalNet, Inc. www.FormsWorkFlow.com