Illinois
Uniform Partnership Act
Statement of Qualification
FORM UPA-1001
April 2010
Secretary of State
Department of Business Services
Limited Liability Division
501 S. Second St., Rm. 357
Springfield, IL 62756
217-524-8008
www.cyberdriveillinois.com
T
his space for use by
Secretary of State.
F
ILE #:
This space for use by Secretary of State.
Date:
Filing Fee: $
Approved:
Federal Employer Identification Number (F.E.I.N.) __________________________________________________
1. Partnership Name:________________________________________________________________________
2. Address of Partnership’s Chief Executive Office: ________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
3. If different from address in number 2, the street address of an office in this state, if any:
______________________________________________________________________________________
______________________________________________________________________________________
4. Registered Agent’s Name and Office Address: (Must be an Illinois resident or company.)
Registered Agent: ________________________________________________________________________
Registered Office: ________________________________________________________________________
5. Filing Fees: Filing fee per partner: $100
Number of partners:
Total filing fee: $
Fees: $100 for each partner, but not less than $200 or more than $5,000.
(Minimum of two partners.)
♻
Printed on recycled paper. Printed by authority of the State of Illinois. June 2010 – 200 – UPA 12.4
(Name must end with “Registered Limited Liability Partnership,” “Limited Liability Partnership,” “R.L.L.P.,” “L.L.P.” or “RLLP.,” “LLP”)
Street Address (Must be a street address. P.O. Box alone is unacceptable.)
City, State, ZIP
First Name Middle Initial Last Name
Street Address City/ZIP
Submit in duplicate. Please type or print clearly.
P
ayment must be made by certified check, cashier’s check,
money order, Illinois attorney’s check or Illinois C.P.A.’s check.
DO NOT STAPLE
(Required to File)