DOMESTIC LLLP FILING FEE: $ 5.00 H STATE OF HAWAII DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS BUSINESS REGISTRATION DIVISION 335 Merchant Street Mailing Address: Annual Filing, P.O. Box 40, Honolulu, HI. 96810 DOMESTIC LIMITED LIABILITY LIMITED PARTNERSHIP ANNUAL STATEMENT AS OF NAME AND MAILING ADDRESS OF PARTNERSHIP (If the above mailing address has changed, line out and print change to the right.) Hawaii 1. Partnership was formed under the laws of: 2. Principal Office Address: (If any change, line out and print change to the right ) 3. Nature of business transacted in Hawaii: (Optional) (If any change, line out and print correction below. If inactive during the period, state INACTIVE.) 4. 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.). 5. Name and address of each general partner: (see instructions) NAME IN FULL ADDRESS ( INCLUDE CITY, STATE & ZIP CODE) CERTIFICATION I certify under the penalties of Section 425E-208, 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: Signature of authorized general partner Print Name B36 B22 FILE NO. Rev. 07/2010 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 general partner liable severally to the state in the amount of $25.00 for each and every month while the default shall continue. The Director of Commerce and Consumer Affairs may cancel the certificate of authority of a domestic limited liability limited partnership for failure to file an annual statement for a period of two years. 1. List the State or Country where the limited liability limited partnership was formed. 2. State the address of the limited liability limited partnership's principal office. 3. (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.) 4. 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 limited liability limited partnership cannot be its own agent. (The Director of Commerce and Consumer Affairs may cancel the certificate of authority of a domestic limited liability limited partnership for failure to maintain a registered agent and registered office.) 5. State the names and addresses of all general partners. (G = General Partner ) (Names and addresses of lmited partners not required) Due Date: Effective January 1, 2003, for a domestic or foreign limited liability limited partnership whose date of registraion 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 limited liability limited 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