Form Llp-1 - Statement Of Qualification Of A Limited Liability Partnership (Domestic Or Foreign) Page 2

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Vermont Secretary of State

STATEMENT OF QUALIFICATION

of a Limited Liability Partnership (Domestic or Foreign)

6. PARTNERS:

REQUIRED – LIST ALL CURRENT PARTNERS

a. Name:

b. Name:

Address:

E-Mail Address:

CHECK IF APPLICABLE:

 This partnership now has more than 2 partners.

MUST ATTACH A COMPLETE LIST OF ADDITIONAL PARTNERS

7. EFFECTIVE DATE:

OPTIONAL

EFFECTIVE DATE MAY BE POST-DATED UP TO 90 DAYS FROM DATE

CERTIFICATION OF STATEMENT:

REQUIRED

I/We hereby certify, under penalty of perjury (11 V.S.A. § 3205(c)), as the partners or authorized filers, that the above information is accurate, a copy of this

statement has been provided to each partner who’s signature does not appear below, and that this statement is provided in duplicate to the secretary of

state with a Check or Money Order made payable to "VT SOS" in the amount of $75.00 (Vermont LLP) or $100.00 (non-Vermont LLP).

Printed Name of Partner or Filer

Signature

Date

Printed Name of Partner or Filer

Signature

Date

PLEASE REVIEW INSTRUCTIONS ON REVERSE BEFORE FILING

11 V.S.A. § 2191, 3302

DIVISION OF CORPORATIONS

FORM LLP-1

(REV. 08/01/14)