Form 08-524 - Domestic Limited Liability Partnership Statement Of Qualification, Form 08-561 - Contact Information Sheet - 2013 Page 3

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State of Alaska
DO NOT STAMP ABOVE THIS BOX
Division of Corporations, Business and Professional Licensing
CORP
Office Use Only
CORPORATIONS SECTION
PO Box 110806
Juneau, AK 99811-0806
Phone: (907) 465-2550
Fax: (907) 465-2974
Website:
STATEMENT OF QUALIFICATION
Domestic Limited Liability Partnership
AS 32.06.911
$250.00 Filing Fee
Pursuant to Alaska Statutes 32.06.911, the undersigned partnership applies for a Certificate of Qualification
and, for that purpose, submits the following statement:
ITEM 1: The legal name of the limited liability partnership, the name must end with “Limited Liability
Partnership,” “L.L.P.,” or “LLP”:
ITEM 2: Registered agent name and address (must include a physical and mailing address in Alaska):
Name:
Physical address:
City:
AK
Zip Code:
Mailing address:
City:
AK
Zip Code:
ITEM 3: The address of the partnership’s chief executive office:
Name:
Physical address:
Mailing address:
ITEM 4: If the chief executive office is not in Alaska, list address of the office in Alaska:
Name:
Physical address:
Mailing address:
ITEM 5: The partnership elects to be a limited liability partnership.
ITEM 6: Effective date of qualification if deferred from date of filing (mm/dd/yyyy format): ___/___/_____
Signatures: The statement filed by a partnership must be executed by at least two partners.
Signature of Partner
Printed Name of Partner
Date
Signature of Partner
Printed Name of Partner
Date
08-524 (Rev. 01/07/2013)
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