STATEMENT OF QUALIFICATION OF FOREIGN LIMITED LIABILITY PARTNERSHIP (UNDER ACT 1518 of 1999) (PLEASE TYPE OR PRINT CLEARLY IN INK) 1. The name of the Limited Liability Partnership is (name must end with “Registered Limited Liability Partnership”, “Limited Liability Partnership”, “R.L.L.P’, “L.L.P”, “FLLP”, or “LLP”.) : ______________________________________ _____________________________________________________________________________________________ 2. State of origination: _____________________________________________________________________________ 3. Street address of the partnership’s chief executive office is:______ ________________________________________ _____________________________________________________________________________________________ Street & Number City, State & ZIP 4. Street address of an office in Arkansas if different from the chief executive office: _____________________________ _____________________________________________________________________________________________ Street & Number City, State & ZIP 5. The name and address of the agent for service of process in the State of Arkansas is: _________________________ _____________________________________________________________________________________________ Street & Number City, State & ZIP 6. Deferred effective date, if any: _____________________________________________________________________ I, hereby, state that the above-listed limited liability partnership is a registered limited liability partnership and satisfies the requirements of the state or other jurisdiction under whose laws it is formed. 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. Executed this ______________________________ day of __________________________, ___________________. ________________________________________________ _____________________________________________ General Partner (Typed or Printed) General Partner (Signature) $300.00 Filing Fee payable to Arkansas Secretary of State Rev. 03/08 American LegalNet, Inc. www.FormsWorkFlow.com Annual Report – Contact Information LIMITED LIABILITY PARTNERSHIP PLEASE TYPE OR PRINT CLEARLY IN INK JURISDICTION (SELECT ONE) □ DOMESTIC □FOREIGN In order for this entity to receive its annual reporting form, please complete and file with the Office of the Secretary of State at the time of filing. _____________________________________________________ __________________________________________________ Entity name as used in Arkansas Contact Person _____________________________________________________ __________________________________________________ Street Address or Post Office Box Number City, State & Zip _____________________________________________________ __________________________________________________ Telephone Number E-mail Address NOTE: Annual Reports will be due on or before April 1st the year following filing or qualification in this state. 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. Executed this ___________ day of _____________, __________________. _____________________________________________________ __________________________________________________ Signature Authorized Officer (Type or Print) Rev. 03/08 American LegalNet, Inc. www.FormsWorkFlow.com