This form must be type written or computer generated. State of Utah Department of Commerce Division of Corporations & Commercial Code Statement of Qualification (Limited Liability Partnership) Important: Read instructions before completing form. Non-Refundable Processing Fee: $22.00 1. Limited Liability Partnership Name: (see instructions for name requirements) 2. Principal office (street address): ________________________________________________________________________________________ Address City State Zip 3. 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: 4. This partnership elects to become a Limited Liability Partnership. 5a. Authorized Partner: (Partners are optional) Name: _______________________________________________________________ _______________________________________________________________ Street Address ______________________________________________________________________________________________ City State Zip 5b. Authorized Partner: (Partners are optional) Attach additional pages if needed to list more partners Name: _______________________________________________________________ _______________________________________________________________ Street Address ______________________________________________________________________________________________ City knowledge and belief, true, correct, and complete. State Zip 6. Under penalties of perjury, I declare that this Certificate of Limited Liability Partnership has been examined by me and is, to the best of my Signature: Name & Title: 7. 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