Form LP 117 August 2012 Secretary of State Department of Business Services Limited Liability Division 501 S. Second St., Rm. 357 Springfield, IL 62756 217-524-8008 www.cyberdriveillinois.com Payment may be made by check payable to Secretary of State. If check is returned for any reason this filing will be void. Please do not send cash. Illinois Uniform Limited Partnership Act FILE # This space for use by Secretary of State. Affidavit of Compliance for Service on Secretary of State SUBMITINDUPLICATE Please type or print clearly. Filing Fee: $50 Approved: 1. Name of Limited Partnership being served: ____________________________________________________________ 2. Title of Case and Case Number: _____________________________ First Named Plaintiff v. _____________________________ First Named Defendant 3. Title of Court in which an action, suit or proceeding has been commenced: ____________________________________ Number_________________________ 4. Title of Instrument being served: ______________________________________________________________________ 5. The Limited Parnership has failed to appoint or maintain an agent for service of process in this State or the agent for service of process and cannot with reasonable diligence be found. This is the basis for service upon the Secretary of State as agent of the limited partnership or foreign limited partnership upon whom process, notice or demand is served. 6. Address to which the affiant will send a copy of this instrument by registered or certified mail: ________________________________________________________________________________________________ Street City, State, ZIP 7. A Copy of the Process, Notice or Demand, together with any papers required by law to be delivered with service, is hereby attached. The undersigned affirms, under penalties of perjury, that the facts stated herein are true, correct and complete. Dated: ________________________________________ Month, Day, Year Return to: __________________________________________________ Name (type or print) ______________________________________ Signature of Affiant ______________________________________ Name (type or print) __________________________________________________ Street Address ______________________________________ Street Address __________________________________________________ City, State, ZIP __________________________________________________ Daytime Telephone Number __________________________________________________ City, State, ZIP This affidavit will be stamped with the date of filing and returned to the affiant as the only proof of filing. Printed on recycled paper. Printed by authority of the State of Illinois. August 2012 -- 1 -- CLP 2.10 American LegalNet, Inc. www.FormsWorkFlow.com