LIMITED LIABILITY PARTNERSHIP ANNUAL REPORT
SECRETARY OF STATE FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS
1. Name and Mailing Address
2. New Mailing Address, if Applicable:
Suite, Apt #, etc.
If above mailing address is incorrect in any way, line through incorrect information and enter correction in Block 2.
3. Principal Place of Business Address
4. New Principal Office Address, if Applicable:
Suite, Apt #, etc.
5. Federal Employer Identification Number
Applied For Not Applicable
6. Certificate of Status Desired:
Additional Fee Required
7. Name and Address of Registered Agent
8. New Name and/or Address of Registered Agent:
Street Address (P.O. Box Number is Not Acceptable)
City Zip Code
9. New Registered Agent's Signature, If Changed
The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida.
SIGNATURE, TYPED OR PRINTED NAME OF REGISTERED AGENT AND TITLE IF APPLICABLE.
10. General Partner's Signature (REQUIRED)
The execution of this report as a partner constitutes an affirmation under the penalties of perjury that the facts stated herein are true.
SIGNATURE AND TYPED OR PRINTED NAME OF SIGNING PARTNER.
Daytime Phone #
PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING THE REPORT. IF YOU NEED ASSISTANCE, PLEASE CALL (850) 245-6051.
1. Form must be typed or printed in ink and legible. 2. Signature in Block 10. 3. Submit with total amount due in the form of a separate check for each filing. (Payable in United States Funds through a United States Bank to Department of State.). This office strongly recommends payment be made by check rather than money order. The cancelled check or money order is critical in settling a dispute regarding the proper filing of a report. It can be extremely difficult to obtain verification when a money order has been processed. Please verify with your bank that your check has cleared before calling for the status of your application. Block 1. Block 2. Block 3. Block 4. Block 5. Block 1 is preprinted with the name and document number. You cannot change the name on this form. You must file an amendment to change the name. Enter new mailing address, if applicable. A Post Office Box is acceptable. Contains current principal place of business address. Enter new principal place of business address, if applicable. A Post Office Box is not acceptable. If blank, complete Block 5 by entering your Federal Employer Identification (FEI) number or checking either applied for or not applicable. If "applied for" was previously reported, you must now provide the FEI number. FEI numbers are not assigned by the Division of Corporations. For assistance with FEI numbers, call the IRS at (800) 829-4933. Should you desire a certificate reflecting your entity's status after the filing of this application, check the BOX in Block 6 and include an additional $8.75 with your filing fee. Block 7 is preprinted with the name and address of the current Registered Agent. Enter the name of the new Registered Agent and/or new Registered Office Address. The Registered Office address must be a Florida Street address. A P.O. Box is NOT acceptable for service of process. A LIMITED LIABILITY PARTNERSHIP CANNOT SERVE AS ITS OWN REGISTERED AGENT; however, a principal of the Limited Liability Partnership can. If a new Registered Agent has been appointed, the new Registered Agent must accept the obligations and this appointment by completing and signing in Block 9. No signature is necessary if the same Registered Agent is retained. If the Registered Agent is a different entity, the person signing must state their position with the entity. This report must be signed in Block 10 with an original signature by a partner of the Limited Liability Partnership.
Block 6. Block 7. Block 8.
Division of Corporations Registration Section P.O. Box 6327 Tallahassee, FL 32314
Registration Section Clifton Building 2661 Executive Center Circle Tallahassee, FL 32301
Phone: (850) 245-6051 Hearing/Voice Impaired may call (850) 245-6096 (TDD)
INFORMATION REGARDING RETURNED CHECK
If the check submitted with this report is returned by a bank for any reason, the report will be cancelled and considered not filed. The Department of State will dissolve/revoke the entity if a replacement payment with service charge and report are not resubmitted within the prescribed time frame. CR2E082-B (1/07)