PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS Return document by mail to: Name Address City State Zip Code Return document by email to: _________________________________ Read all instructions prior to completing. Fee: $70 Check one: Statement of Amendment (§ 8201B) Statement of Termination (§ 8201C) In compliance with the requirements of 15 Pa.C.S. § 8201 (relating to amendment of registration/statement of termination), the undersigned desiring to amend/terminate its registration as a domestic limited liability partnership or domestic limited liability limited partnership, hereby certifies that: 1. The name of the domestic limited liability partnership or limited liability limited partnership is: 2. Check and complete one of the following: The partnership is a general partnership and the address, including number and street, if any, of its principal place of business is: Number and street City State Zip County The partnership is a limited partnership and the (a) address of its current registered office in this Commonwealth or (b) name of its commercial registered office provider and the county of venue is: (Complete (a) or (b), not both) (a) Number and Street City State Zip County c/o: (b)Name of Commercial Registered Office Provider County Complete 3-4 for Statement of Amendment Only: 3. The amendment authorized by the partnership is set forth in full in the restated Statement of Registration, attached hereto as an exhibit. The attached restated Statement of Registration supersedes the original Statement of Registration and all previous amendments thereto. 4. The amendment has been authorized by at least a majority in interest of the partners. American LegalNet, Inc. www.FormsWorkFlow.com DSCB:15-8201B/8201C­2 Complete 5-6 for Statement of Termination Only: 5. The registration of the partnership under the provisions of 15 Pa.C.S. § 8201 (relating to statement of termination) is hereby terminated. 6. The termination has been authorized by all of the general partners. 7. Effective date of amendment or termination of registration (check, and if appropriate complete, one of the following): The Statement of Amendment/Termination shall be effective upon filing in the Department of State. The Statement of Amendment/Termination shall be effective on: _______________________ at ____________. Date (MM/DD/YYYY) Hour (if any) IN TESTIMONY WHEREOF, the undersigned general partner of the domestic limited liability partnership/limited liability limited partnership has executed this Statement of Amendment/Termination this _________ day of _____________________, __________. ________________________________________________________ Name ________________________________________________________ Signature ________________________________________________________ Title American LegalNet, Inc. www.FormsWorkFlow.com DSCB:15-8201B/8201C­Instructions Pennsylvania Department of State Bureau of Corporations and Charitable Organizations P.O. Box 8722 Harrisburg, PA 17105-8722 (717) 787-1057 Website: www.dos.pa.gov/corps General Information Typewritten is preferred. If handwritten, the form must be legible and completed in black or blue-black ink in order to permit reproduction. The nonrefundable filing fee for this form is $70. Checks should be made payable to the Department of State. Checks must contain a commercially pre-printed name and address. This form and all accompanying documents, including any necessary governmental approvals, shall be mailed to the address stated above. Who should file this form? A general partnership registered as a limited liability partnership or a limited partnership registered as a limited liability limited partnership may file a Statement of Amendment/Termination to amend its registration or terminate its status as a limited liability partnership. Applicable Law For requirements on limited liability partnerships and limited liability limited partnerships, see 15 Pa.C.S. §§ 8201-8244. Statutes are available on the Pennsylvania General Assembly website, www.legis.state.pa.us, by following the link for Statutes. Definitions A limited liability partnership is a domestic or foreign general partnership for which there is in effect: (1) a statement of registration under Chapter 82 (relating to limited liability partnerships and limited liability limited partnerships); or (2) a similar filing under the organic law of a foreign general partnership. A limited liability limited partnership is a domestic or foreign limited partnership for which there is in effect: (1) a statement of registration under Chapter 82; (2) a provision of its certificate of limited partnership electing to be subject to Chapter 82; or (3) a similar filing or provision under the organic law of a foreign partnership. or mailing addresses provided on this form will become part of the filed document and therefore public record. 1. Give the exact name of the limited liability partnership or limited liability limited partnership. The name on this line must match exactly the association name as shown in Department's records at the time the Statement of Amendment/Termination is submitted for filing. This field is required. 2. Current address. The address provided must be the limited liability partnership's principal place of business or the limited liability limited partnership's registered office address as on file with the Department of State at the time the Statement of Amendment/Termination is submitted for filing. The registered office address may be a number and street address or the name of a Commercial Registered Office Provider. Under 15 Pa.C.S. § 135(c) (relating to addresses) an actual street or rural route box number must be used as an address, and the Department of State is required to refuse to receive or file any document that sets forth only a post office box address. This field is required. Instructions for Amendment Only (3-4): A Statement of Amendment shall be filed upon the occurrence of any of the following events: (1) A change in the name of the limited liability partnership. (2) A change in address of the limited liability partnership. This form may be used by both limited liability partnerships and limited liability limited partnerships to file a change in address. DSCB:15-1507/5507/8625/8825 (Statement or Certificate of Change of Registered Office) may be used by a domestic limited partnership which has registered as a limited liability limited partners