Important: Read instructions before completing form. Non-Refundable Processing Fee: $22.00
1. Limited Liability Partnership Name:
(see instructions for name requirements)
2. Principal office (street address):
____
____________________________________________________________________________________
Address City State Zip
3. The name of the Registered Agent (Individual or Business Entity or Commercial Registered Agent):
________________________________________________________________________________________
The address must be listed if you have a non-commercial registered agent. See instructions for further details.
Address of the Registered Agent: ___________________________________________________________
Utah Street Address Required, PO Boxes can be listed after the Street Address
City: State UT Zip:
4. This partnership elects to become a Limited Liability Partnership.
5a. Authorized Partner:
(Partners are optional)
Name: _______________________________________________________________
_______________________________________________________________
Street Address
______________________________________________________________________________________________
City State Zip
5b. Authorized Partner:
(Partners are optional)
Attach additional pages if needed to list
more partners
Name: _______________________________________________________________
_______________________________________________________________
Street Address
______________________________________________________________________________________________
City State Zip
6. Under penalties of perjury, I declare that this Certificate of Limited Liability Partnership has been examined by me and is, to the best of my
knowledge and belief, true, correct, and complete.
Signature: Name & Title:
7. Purpose of the Limited Liability Partnership:
(optional)
Under GRAMA {63G-2-201}, all registration
information maintained by the Division is classified as public record. For confidentiality purposes, you
may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity.
Optional Inclusion of Ownership Information: This information is not required.
Is this a female owned business? Yes No
Is this a minority owned business? Yes No If yes, please specify:
State of Utah
Department of Commerce
Division of Corporations & Commercial Code
Statement of Qualification (Limited Liability Partnership)
This form must be type written or computer generated.
Sign here after the form is printed
Select/Type the race of the owner here
Mailing/Faxing Information:
www.corporations.utah.gov/contactus.html
www.corporations.utah.gov
