STATEMENT OF QUALIFICATION OF FOREIGN LIMITED LIABILITY PARTNERSHIP (PLEASE TYPE OR PRINT CLEARLY IN INK) 1. The name of the Limited Liability Partnership is: _______________________________________________________ _____________________________________________________________________________________________ 2. State of origination: _____________________________________________________________________________ 3. Street address of the principal office in the state of organization is: ________________________________________ _____________________________________________________________________________________________ Street & Number City, State & ZIP 4. Street address of an office in Arkansas if different from the principal 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. 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