Form LP 210
August 2012
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Printed on recycled paper. Printed by authority of the State of Illinois. August 2012 — 1 — C LP 12.15
Please type or print clearly.
F
iling Fee: $100
Approved:
Do not make changes on this form. To change the Agent and/or Designated Office, sub-
mit Form LP 115 along with the $50 filing fee. For all other changes, submit LP 202 (Illi-
nois) or LP 902.5 (foreign) along with the $50 filing fee.
1.
Limited Partnership Name
:
__________________________________________________________________
2. Address of Office at which records required by Section 111 (Illinois) or Section 902 (Foreign) are kept:
________________________________________________________________________________________
Street Address (P.O. Box alone is unacceptable.)
________________________________________________________________________________________
City, State, ZIP
3. Foreign Alternate Name, if any:
____________________________________________________________
4. Registered Agent: ______________________________________________________________________
Name
Registered Office:______________________________________________________________________
Street Address (P.O. Box alone is unacceptable.)
____________________________________________________________________________________
City ZIP
5. State or Jurisdiction of Organization:
________________________________________________________
The Annual Report must be signed by a General Partner. I affirm that any entity serving as a General Partner
for this Limited Partnership is in good standing in its home state. The undersigned affirms, under penalties of per-
jury, that the facts stated herein are true, correct and complete.
Date: ____________________________________ __________________________________________
Month, Day, Year General Partner Name if a corporation or other entity
________________________________________ __________________________________________
Signature Name and Title (type or print)
Date: ____________________________________ __________________________________________
Month, Day, Year General Partner Name if a corporation or other entity
(must be in good standing)
Signatures must be in black ink on an original document.
IL
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
This space for use by Secretary of State.
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Payment may be made by check
payable to Secretary of State. If check
is returned for any reason this filing
will be void.
P
lease do not send cash.
