Supreme-14 (revised April 2019) STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS SUPREME COURT CLERK222S OFFICE 2019 - 2020 ANNUAL LLE REGISTRATION STATEMENT LLE Number: LLE Name and Address: Status: Number of Attorneys: Telephone: Contact Attorney: Email: Article II, Rule 10(e) requires that this office be notified within thirty (30) days of any change in the facts set forth in the application for license filed with the clerk, including: 1. The name and address of the limited liability entity; 2. The names and addresses of all shareholders, directors and officers (professional service corporations); partners (limited liability partnership), and managers and members (limited liability company), each of whom must be an attorney licensed to practice law; 3. The names and address of all attorneys who will practice law in Rhode Island; and 4. The name and address of the insurance company writing the insurance. (Current insurance certificates must be on file with the Clerk222s Office.) Please see the current Application for Limited Liability Entity License for additional information that must be reported to the Clerk222s Office and updated within thirty (30) days of any change. Please note that limited liability partnerships must submit to this office renewal information filed with the Rhode Island Secretary of State within thirty (30) days. Application updates must be submitted with this registration statement. Any changes made outside of the registration cycle must be made using the Limited Liability Amendment/Change in Circumstances and LLP Renewal Form. Compliance with the annual limited liability entity registration process requires payment of the LLE Registration Fee and submission of a completed Annual LLE Registration Statement by July 1 each year. Article IV, Rule 1A. A postmark date of July 1, 2019 or earlier is required to be deemed timely. Late registrations are subject to a $125.00 late fee. Checks should be made payable to the Rhode Island Supreme Court. N umber of Attorneys Registration Fee Payments Received After July 1 Deadline Fewer than five (5) $200.00 $200.00 + $125.00 Between five (5) and ten (10) $300.00 $300.00 + $125.00 Eleven (11) or more $500.00 $500.00 + $125.00 By signing below, on behalf of the entity I certify: and I acknowledge that failure to timely comply with the annual LLE registration process will result in the assessment of a late fee and the revocation of the entity222s license to practice law in this state without further notice; that this entity is currently covered by liability insurance as required by Rhode Island General Laws and a valid insurance certificate is on file with the Clerk222s Office or is attached hereto; and that the entity is in compliance with court rules and applicable provisions in the Rhode Island General Laws. Contact Attorney Signature: Date: Please direct questions to lleinfo@courts.ri.gov . American LegalNet, Inc. www.FormsWorkFlow.com