DOMESTIC GENERAL PARTNERSHIP FILING FEE: $ 5.00 DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS STATE OF HAWAII BUSINESS REGISTRATION DIVISION H 335 Merchant Street Mailing Address: Annual Filing, P.O. Box 40, Honolulu, HI. 96810 DOMESTIC GENERAL PARTNERSHIP ANNUAL STATEMENT AS OF: PARTNERSHIP NAME AND MAILING ADDRESS: (If the above mailing address has changed, line out and print change to the right.) 1. Principal Office Address: (If any change, line out and print change to the right) 2. NATURE OF BUSINESS: (Optional) (To correct, line out and print corrections below. If inactive during the period, state INACTIVE.) 3. The name of the registered agent and the registered agent's street address of the place of business in Hawaii of the person to which service of process and other notice and documents being served on or sent to the entity represented by it may be delivered to. (If any change, line out and print change on the right. See reverse side for instructions.). 4. None of the partners is either a minor or incompetent person. 5. Below are the name and address of each general partner. (If there were any changes to the list, line out deleted names or insert new names and addresses.) NAME IN FULL ADDRESS (INCLUDE CITY, STATE & ZIP CODE CERTIFICATION I certify under the penalties of Section 425-13, Hawaii Revised Statutes, that I have read the above and the information is true and correct, and I am authorized to sign this report. DATE: FILE NO. Rev. 10/2013 Signature of authorized general partner Print Name B36 B22 BSA File this Original (SEE REVERSE SIDE FOR INSTRUCTIONS) American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS (If any questions, call (808) 586-2727) The annual statement must be typewritten or printed in Black Ink, and must be legible. The statement must be signed in black ink and certified by an authorized general partner. The filing fee of $ 5.00 must be submitted with the statement. Make check payable to the DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS. Filing fee is not refundable. Your cancelled check is your receipt. There is a $ 25.00 charge for all dishonored checks. Failure to file an annual statement for any year within the prescribed time will make each partner liable severally to the state in the amount of $25 for each and every month while the default shall continue. The Director of Commerce and Consumer Affairs may cancel the registration for failure to file an annual statement for a period of two years. 1. State the address of the partnership's principal office. 2. (Optional) State a brief description of the nature of business. If inactive for the period, state INACTIVE. (Annual statement must be filed for the period, even though the partnership was inactive.) 3. State the name of the registered agent and the complete street address (including number, street, city, state, and zip code) in Hawaii. The agent must be an individual resident of Hawaii, a domestic entity, or a foreign entity authorized to transact business or conduct affairs in the State of Hawaii. A domestic partnership cannot be its own agent. (The Director of Commerce and Consumer Affairs may cancel the registration for failure to maintain a registered agent and registered office.) 4. The statement that none of the partners is either a minor or incompetent person is required. 5. State the names and business addresses of all general partners. Due Date: Effective January 1, 2003, for a domestic or foreign partnership whose date of registration in this State falls between: (1) January 1 and March 31, an annual statement shall be filed on or before March 31 of each year and shall reflect the state of the partnership's affairs as of January 1 of the year when filed; (2) April 1 and June 30, an annual statement shall be filed on or before June 30 of each year and shall reflect the state of the partnership's affairs as of April 1 of the year when filed; (3) July 1 and September 30, an annual statement shall be filed on or before September 30 of each year and shall reflect the state of the partnership's affairs as of July 1 of the year when filed; and (4) October 1 and December 31, an annual statement shall be filed on or before December 31 of each year and shall reflect the state of the partnership's affairs as of October 1 of the year when filed. New partnerships: An annual statement is not required to be filed in the year the partnership was registered. This material can be made available for individuals with special needs. Please call the Division Secretary, Business Registration Division, DCCA, at 586-2744, to submit your request. All Business Registration filings are open to public inspection. (Section 92F-11, HRS) Mail the completed statement with fee to: Annual filing - BREG P.O. Box 40 Honolulu, HI 96810 DID YOU REMEMBER TO SIGN YOUR STATEMENT AND CHECK? Renew online at www.ehawaii.gov/annuals American LegalNet, Inc. www.FormsWorkFlow.com