This form must be type written or computer generated. State of Utah Department of Commerce Division of Corporations & Commercial Code Foreign Registration Statement (Limited Liability Partnership) Important: Read instructions before completing form. Non-Refundable Processing Fee: $22.00 1. Limited Liability Partnership name: ___________________________________________________________________________________________________ (Name of Limited Liability Partnership in the Home State ­ see instructions for name requirements) 2. Jurisdiction of qualification: 3. Principal office address: _______________________________________________________________________________________ Address City State Zip 4. The name of the Registered Agent (Individual or Business Entity or Commercial Registered Agent): ________________________________________________________________________________________ The address must be listed if you have a non-commercial registered agent. See instructions for further details. Address of the Registered Agent: ___________________________________________________________ Utah Street Address Required, PO Boxes can be listed after the Street Address City: State UT Zip: 5a. Partner Name & Address: (Partners are optional) Name: _________________________________________________________ __________________________________________________________ Street Address _______________________________________________________________________________________ City State Zip 5b. Partner Name & Address: (Partners are optional) Name: _________________________________________________________ __________________________________________________________ Street Address _______________________________________________________________________________________ City State Zip 6. The Limited Liability Partnership shall use as its name in Utah: ___________________________________________________________________________________________ Must be the same as number (1) unless the name is not available or permitted in Utah. 7. Under penalties of perjury and as an authorized partner, I declare that this application, and if applicable, the statement of change of registered office and/or agent, has been examined by me and is, to the best of my knowledge and belief, true, correct, and complete. Authorized Signer Signature: Name & Title: 8. Purpose of the Limited Liability Partnership: (optional) Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity. Optional Inclusion of Ownership Information: This information is not required. Is this a female owned business? Yes No Is this a minority owned business? Yes No If yes, please specify: Select/Type the race of the owner here 01/14 American LegalNet, Inc. www.FormsWorkFlow.com