Certificate Of Conversion From A Non-Delaware Partnership To A Delaware Limited Liability Partnership - Delaware Division Of Corporations - 2005 Page 4

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STATE OF DELAWARE
STATEMENT OF QUALIFICATION
1.
The name of the limited liability partnership is ____________________________
_________________________________________________________________.
2.
The address of its registered office in the State of Delaware is
__________________________________________________________________
in the City of ______________________________________________________
Zip Code_______________.
The name and address of the registered agent is___________________________
_________________________________________________________________.
3.
The number of partners of the limited liability partnership is __________.
4.
The partnership elects to be a limited liability partnership.
5.
The effective date of this Statement of Qualification is_____________________.
IN WITNESS WHEREOF, the undersigned have executed this Statement of
Qualification this ______ day of ____________________, ____________A.D.
By:_______________________________
Authorized Person or Partner
Name:______________________________
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