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 Statement of Registration or Renewal of Limited Liability Partnership (Domestic Partnership) KLL __________________________________________________________________________________________ Pursuant to the provisions of KRS 14A and KRS 362, the undersigned applies for registration or renewal and, for that purpose, submits the following statement: 1. The activity request is: Registration Renewal 2. The name of the registered limited liability partnership is __________________________________________________. 3. The principal office address is: _____________________________________________ _________________________ ____________ _____________. Street Address or Post Office Box Numbers City State Zip Please note: This filing is applicable to filings wishing to be governed under KRS 362.555. 4. The number of partner(s) is ________________________________________________________________________. 5. The names of the partner(s) are: _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 6. The nature of the business of the partnership is: _________________________________________________________________________________________________ _________________________________________________________________________________________________ ________________________________________________________________________________________________. 7. This application 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) I declare under penalty of perjury under the laws of Kentucky that the forgoing is true and correct. ________________________________ _________________________ ___________________ __________________ Signature of Partner Printed Name Title Date (01/12) American LegalNet, Inc. www.FormsWorkFlow.com FILING INSTRUCTIONS REGISTRATION OR RENEWAL OF A LIMITED LIABILITY PARTNERSHIP NAME Use the exact name of the business entity as registered on file with the Office of the Secretary of State. 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. 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. 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 th or the delayed effective date cannot be prior to the date the application is filed. A delayed effective date may not be later than the 90 day after the date of filing. WHO MAY SIGN The document must be signed by a majority in interest of the partners or by one or more partners authorized to execute the document. NATURE OF BUSINESS The limited liability company must give a brief description of the nature of the business in which it is engaged. NUMBER OF COPIES If filing via mail or in person, all business entities, with exception to nonprofit, are only required to submit one exact or conformed copy. Nonprofit corporations are required to submit the original signed certificate of authority and two exact or conformed copies. 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. FILING FEE The filing fee for this document is $200.00. 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 AND NAME AVAILABILITY If you have any questions, need additional forms or wish to search for name availability, please feel free to visit our website at www.sos.ky.gov or call our office at 502-564-3490. (01/12) American LegalNet, Inc. www.FormsWorkFlow.com