Form Inhs66 - Statement Of Qualification For Florida Limited Liability Limited Partnership - 2005 Page 2

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STATEMENT OF QUALIFICATION FOR
FLORIDA LIMITED LIABILITY LIMITED PARTNERSHIP
1. The name of the limited partnership as identified in the records of the Florida Department of State:
.
Insert limited partnership’s Florida document number: _____________________________
or
Attach certificate of limited partnership, affidavit of capital contributions and applicable limited
partnership filing fees.
2. The complete name of the entity after filing Statement of Qualification shall be:
(Must include LLLP or L.L.L.P.)
3.
The street address of its chief executive office:
(if different from current recorded address):
4.
The street address of principal office in Florida:
(if different from above)
5. The limited partnership hereby elects to be a limited liability limited partnership.
6. The effective date of this filing shall be:
as of the date this document is filed with the Florida Secretary of State
or
___ a date later than the time of filing: ___________________.
7. The name and Florida street address of the partnership’s agent for service of process:
, Florida
The execution of this statement as a partner constitutes an affirmation under the penalties of perjury that the facts stated
herein are true.
Signed this _________ day of _______________________, ________.
Signature of TWO Partners:
Typed or printed names of partners signing above:
_______________________________
_______________________________
Filing Fee: $25.00
Certified Copy (optional): $52.50
Certificate of Status (optional): $8.75
INHS66 (8/05)

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