PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS Certificate of Annual Registration (15 Pa.C.S.) Registered Limited Liability Partnership (§ 8221) Limited Liability Company (§ 8998) Name Document will be returned to the name and address you enter to the left. Address City State Zip Code Fee: See Instructions C. and E. In compliance with the requirements of the applicable provisions (relating to annual registration), the undersigned domestic or foreign registered limited liability partnership/limited liability company, hereby states that: 1. The name of the registered limited liability partnership/limited liability company is: Limited Liability Partnership: complete only paragraph 2 2. The prescribed annual base fee of $310 times partners of this partnership on December 31, this Certificate of Annual Registration. (the number of persons who were general (year) and who are described in § 8221(b)(1)) accompanies Limited Liability Company: complete only paragraphs 3 and 4 3. Check, and if appropriate complete, one of the following: The company did not engage in any business not permitted by § 8996(a) (relating to purposes of restricted professional companies) during the year with respect to which this certificate is being filed. The company did engage in business not permitted by § 8996(a) (relating to purposes of restricted professional companies) during the year with respect to which this certificate is being filed. 4. The prescribed annual base fee of $460 times (the number of persons who were members of this company on December 31, (year) and who are described in § 8998(b)(1)) accompanies this Certificate of Annual Registration. IN TESTIMONY WHEREOF, the undersigned general partner/member has executed this Certificate of Annual Registration this day of , . Signature Rev. 9/12 American LegalNet, Inc. www.FormsWorkFlow.com Department of State Bureau of Corporations and Charitable Organizations P.O. Box 8722 Harrisburg, PA 17105-8722 (717) 787-1057 Web site: www.dos.state.pa.us/corps General Instructions for Completion of Form: A. This form must be filed on or before April 15 of each year following the year with respect to which it is being filed. B. This form and all accompanying documents shall be mailed to the address stated above. Instructions for Annual Registration for Registered Limited Liability Partnership C. Typewritten is preferred. If not, the form shall be completed in black or blue-black ink in order to permit reproduction. The annual fee of $310 times the number of persons who were general partners of the partnership on December 31 shall accompany this form and shall be made payable to the Department of State. The base fee of $310 was increased on December 31, 2009. See § 8221(b)(2). Failure to file the annual registration by April 15 will result in a lien on the assets of the partnership. If a certificate of annual registration is not filed by May 15, a penalty of $500 will be assessed against the partnership, which will create a second lien on the assets of the partnership. D. The annual fee is required to be paid only with respect to a general partner who: (1) in the case of a natural person, had his principal residence in Pennsylvania, or (2) in the case of any other person, was incorporated or otherwise organized or existing under the laws of Pennsylvania. See § 8221(b)(1). Instructions for Annual Registration for Limited Liability Company E. Typewritten is preferred. If not, the form shall be completed in black or blue-black ink in order to permit reproduction. The annual fee of $460 times the number of persons who were members of the company on December 31 shall accompany this form and shall be made payable to the Department of State. The base fee of $460 was increased on December 31, 2009. See § 8998(b)(2). Failure to file the annual registration by April 15 will result in a lien on the assets of the company. If a certificate of annual registration is not filed by May 15, a penalty of $500 will be assessed against the company, which will create a second lien on the assets of the company. F. The annual fee is required to be paid only with respect to a member who: (1) was licensed to practice the professional service rendered by the company; and (2) had principal residence in Pennsylvania. See § 8998(b)(1). American LegalNet, Inc. www.FormsWorkFlow.com