PARTNERSHIP REGISTRATION STATEMENT
1.
(Name of Partnership)
2. 3.
(State/County of Formation) (FEI Number)
4.
(Street Address of Chief Executive Office)
5.
(Street Address of Principal Office in Florida, if applicable)
6
.
I
n accordance with s. 620.8105(1)(c)(1 & 2), Florida Statutes, required partner information is provided in one of the
following options:
☐ A
ttached is a list of the names and mailing addresses of ALL partners and Florida Registration Numbers, if othe
r
than individuals, or:
☐ T
he name and street address of the agent in Florida who shall maintain a list of the names and addresses
of all partners
:
IF OTHER THAN INDIVIDUAL,
NAME & FLORIDA STREET ADDRESS FLORIDA REGISTRATION
OF FLORIDA AGENT NUMBER
I
f any of the partners are other than individuals, its entity name and Florida Registration Number must be listed below:
Partner Entity Name Florida Document Number
7. Effective date, if other than the date of filing: .
(Effective date cannot be prior to the date of filing nor more than 90 days after the date of filing.)
NOTE: If the date inserted in this block does not meet the applicable statutory filing requirements, this date will not be listed
as the document’s effective date on the Department of State’s records.
The execution of this statement constitutes an affirmation under the penalties of perjury that the facts stated herein are true.
We are aware that any false information submitted in a document to the Department of State constitutes a third degree felony
as provided for in s. 817.155, F.S.
Signed this day of , .
Signatures of TWO Partners:
Typed or printed names of partners signing above:
D
ivision of Corporations P.O. Box 6327 Tallahassee, FL 32314
Certified copy: $52.50 (optional)
Certificate of Status: $ 8.75 (optional)
