COMMONWEALTH OF KENTUCKY ALISON LUNDERGAN GRIMES, SECRETARY OF STATE _________________________________________________________________________________________________________________________ Division of Business Filings Business Filings PO Box 718 Frankfort, KY 40602 (502) 564-3490 www.sos.ky.gov Amendment to the Statement of Qualification SQA __________________________________________________________________________________________ Pursuant to the provisions of KRS 14A and KRS 362, the undersigned hereby amends the registration on behalf of the limited liability partnership named below and, for that purpose, submits the following statements: 1. The name of the limited liability partnership: _______________________________________________________________________________________________ (Name must be identical to the name of record with the Office of the Secretary of State) 2. The statement of qualification is amended as follows. _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ 3. This amendment will be effective upon filing, unless a delayed effective date and/or time is provided. The effective date or the delayed effective date cannot be prior to the date the application is filed. The date and/or time is ______________. (Delayed effective date and/or time) We declare under penalty of perjury under the laws of the state of Kentucky that the foregoing is true and correct. _________________________________________________________________________________________________________________________ Signature of Partner Printed Name Title Date _________________________________________________________________________________________________________________________ Signature of Partner Printed Name Title Date (01/12) American LegalNet, Inc. www.FormsWorkFlow.com FILING INSTRUCTIONS AMENDMENT TO STATEMENT OF QUALIFICATION NAME State the exact name of the partnership as registered with the Office of the Secretary of State. AMENDMENT State the text of amendment. WHO MAY SIGN The document must be signed by two partners. PRINCIPAL OFFICE ADDRESS The principal office is the office (in or out of this state) so designated in writing with the Office of the Secretary of State where the principal designated office of the business entity is located. This address is where all correspondence from the Office of the Secretary of State (See Document Delivery) will be mailed. EFFECTIVE DATE AND TIME The document will be effective on the date and time of filing, unless a delayed effective date and/or time is specified. The effective date or the delayed effective date cannot be prior to the date the application is filed. A delayed effective date th may not be later than the 90 day after the date of filing. NUMBER OF COPIES If filing via mail or in person, one exact or conformed copy of the document with the filing fee must be submitted to the address below. To make a copy of the filing for delivery to the local county clerk's office, visit www.sos.ky.gov and print a copy from the organization search tool. DOCUMENT DELIVERY A file stamped postcard will be sent to the principal office address. If the applicant wishes for the document to be sent to an alternate address other than the principal office, a request must be submitted in writing affirming that request. Alternate address requests must be submitted with each document filed with the Office of the Secretary of State. FILING FEE The filing fee is $40.00. Checks should be made payable to the "Kentucky State Treasurer." MAILING ADDRESS Alison Lundergan Grimes Secretary of State P. O. Box 718 Frankfort, KY 40602-0718 OFFICE LOCATION Room 154, Capitol Building 700 Capital Avenue Frankfort, KY 40601 Hours of Operation: 8:00 AM-4:30 PM ET CONTACT INFORMATION If you have any questions or need additional forms, please feel free to visit our website at www.sos.ky.gov or call (502) 564-3490. (01/12) American LegalNet, Inc. www.FormsWorkFlow.com