Limited Liability Partnership Statement Of Qualification Form - Minnesota Secretary Of State
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1MINNESOTA SECRETARY OF STATE
LIMITED LIABILITY PARTNERSHIP
STATEMENT OF QUALIFICATION
CHAPTER 323A
PLEASE TYPE OR PRINT IN BLACK INK.
Please read the instructions on the reverse side before completing.
Fee: $135
1. List the Partnership name : ____________________________________________________________________________
_______________________________________________________________________________________________________
2. Address of the partnership’s chief executive office: (Please note: PO Box is unacceptable)
_______________________________________________________________________________________________________
Complete Street Address or Rural Route and Rural Route Box Number
City
State
ZIP
3. List office of partnership in Minnesota, if different from item 2 (if the partnership does not have an office in this state, list
the name and complete address of the partnership’s agent for service of process): (Please note: PO Box is unaccept-
able)
_______________________________________________________________________________________________________
Complete Street Address or Rural Route and Rural Route Box Number
City
State
ZIP
4. This partnership elects to be a limited liability partnership.
5.
The effective date of this filing if different from the date of filing, is: _____________________________________.
6.
I certify that I am a partner authorized to sign this document on behalf of this partnership and I further certify that by
signing this document I am subject to the penalties of perjury as set forth in Minnesota Statutes, section 5.15 as if I had
signed this document under oath. Note that this statement must be signed/executed by at least two (2) partners.
_________________________________________
________________________________________
Signature of a partner (Required)
Signature of a partner (Required)
_________________________________________
________________________________________
Print name and daytime telephone number
Print name and daytime telephone number
10980529 Rev. 12/00
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