Free Renewal Statement of Domestic Limited Liability Partnership - Illinois

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FORM UPA-1003-(D)
March 2008
Secretary of State Department of Business Services Limited Liability Division 501 S. Second St., Rm. 357 Springfield, IL 62756 217-785-8960 www.cyberdriveillinois.com
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Illinois Uniform Partnership Act
Renewal Statement of Domestic Limited Liability Partnership
Payment may be made by check payable to Secretary of State.

File #:

This space for use by Secretary of State.

This space for use by Secretary of State. Date: Filing Fee: Approved:

This renewal application is effective for one year, and will expire if not renewed within 60 days prior to the anniversary date of the original registration with the Secretary of State. DO NOT MAKE CHANGES ON THIS FORM. IF CHANGES ARE NECESSARY, AMENDMENT FORM UPA-1001(h)/1102(g) AND THE $25 FEE IS REQUIRED. 1. Registered Limited Liability Partnership Name: __________________________________________________ ______________________________________________________________________________________ 2. Federal Employer Identification Number (FEIN): __________________________________________________ 3. Effective Date of Initial Registration: ________________________________________________________ 4. Address of Chief Executive Office (P.O. Box alone and c/o are unacceptable.): __________________________ ______________________________________________________________________________________ 5. Illinois Registered Agent: __________________________________________________________________ Illinois Registered Office (P.O. Box alone and c/o are unacceptable.): ________________________________ ______________________________________________________________________________________ 6. Total Number of Partners (minimum of 2): ________________________________________________________ Fee Per Partner (x $100) (minimum of $200): ____________________________________________________ Total Filing Fee (In no event shall the fee exceed $5,000.): ________________________________________

Printed on recycled paper. Printed by authority of the State of Illinois. September 2008 -- 500 -- RLLP 2.9

UPA-1003-(D)

7. Brief statement of the business in which the partnership engages:

8. The partnership hereby applies for continual status as a registered Limited Liability Partnership. 9. The undersigned affirms, under penalties of perjury, having authority to sign hereto, that this renewal application is to the best of my knowledge and belief, true, correct and complete. Dated
Month, Day

20
Year

1.

Signature

1.

Street Address

Name and Title (type or print)

City/Town

Name if a Corporation or other Entity

State, ZIP

2.
Signature

2.
Street Address

Name and Title (type or print)

City/Town

Name if a Corporation or other Entity

State, ZIP

3.
Signature

3.
Street Address

Name and Title (type or print)

City/Town

Name if a Corporation or other Entity

State, ZIP

4.
Signature Name and Title (type or print)

4.
Street Address City/Town

Name if a Corporation or other Entity

State, ZIP

Printed on recycled paper. Printed by authority of the State of Illinois. September 2008 -- 500 -- RLLP 2.9