Mark Martin, Arkansas Secretary of State LIMITED PARTNERSHIP/LIMITED LIABILITY LIMITED PARTNERSHIP ANNUAL REPORT 2015 Report Due May 1 (PLEASE TYPE OR PRINT CLEARLY IN BLACK INK) The undersigned, pursuant to A.C.A. � 4-47-210, sets forth the following: Domestic 1. Name of the Limited Partnership/Limited Liability Limited Partnership: 2. Street Address (Designated Office in Arkansas): City: Email Address: Mailing Address (Designated Office in Arkansas, if different than above): City: 3. Agent for Service of Process: Street Address: City: 4. Tax Contact Name: Mailing Address: City: Foreign Office Street Address: City: State: Zip: State: Zip: 5. If a Foreign Limited Partnership/Limited Liability Limited Partnership: State: Zip: State: Zip: State: Zip: Foreign Foreign Office Mailing Address (if different than above): City: Jurisdiction under which entity was formed: Fictitious Name or Alternate Name used in Arkansas: 6. List of Partners: General Partner/ Partner: General Partner/ Partner: General Partner/ Partner: Tax Preparer: State: Zip: 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