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, cashiers check,
money order, Illinois attorney’s check or Illinois C.P.A.s check.
DO NOT STAPLE
(Required to File)
Print
Reset
Printed on recycled paper. Printed by authority of the State of Illinois. June 2010 – 200 – UPA 12.4
6. Total Number of Partners:
7. Names and Mailing Addresses of all Partners:
8. Brief statement of the business in which the partnership engages:
9. The Partnership hereby applies for status as a Limited Liability Partnership.
10. Registration Application is effective on (check one):
o a) the filing date
o b) another date later than but not more than 60 days subsequent to the filing date:
11. We declare, under the penalty of perjury, under the laws of the State of Illinois, that the foregoing is true,
correct and complete.
Executed on the ___________of _______________ , ___________ by at least two partners.
Please submit this form in duplicate along with $100 for each partner,
but not less than $200 or more than $5,000, minimum two partners.
Signatures must be in BLACK INK on an original document.
Carbon copy, photocopy or rubber stamp signatures may only be used on conformed copy.
For additional space, continue in the same format on a plain white 8.5x11” sheet of paper.
Signature
Day Month Year
Number, Street Address
Name and Title (type or print) City, State, ZIP
Signature Number, Street Address
Name and Title (type or print) City, State, ZIP
Name, Street Address, City, State, ZIP
Name, Street Address, City, State, ZIP
Name, Street Address, City, State, ZIP
Month, Day, Year