Mark Martin, Arkansas Secretary of State LIMITED PARTNERSHIP/LIMITED LIABILITY LIMITED PARTNERSHIP ANNUAL REPORT 2017 (PLEASE TYPE OR PRINT CLEARLY IN BLACK INK) Report Due May 1 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: Mailing Address (if different than above): City: 4. Tax Contact Name: Mailing Address: City: State: Zip: State: Zip: State: Zip: State: Zip: State: Zip: Foreign 5. If a Foreign Limited Partnership/Limited Liability Limited Partnership: Principal Office Street Address: City: State: Zip: Principal 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: Executed this ______________ day of _________________________, _____________ (Day) (Month) (Year) State: Zip: ______________________________________________ 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: corprequest@sos.arkansas.gov · Website: www.sos.arkansas.gov Filing Fee: $15.00 ­ Remittance must accompany this report. American LegalNet, Inc. www.FormsWorkFlow.com Rev. 12/16