STATEMENT OF QUALIFICATION
Secretary of State Office
500 E Capitol Ave
OF A FOREIGN
Pierre, SD 57501
Clear Form
(605)773-4845
LIMITED LIABILITY LIMITED
PARTNERSHIP
Please Type or Print Clearly in Ink
Original
Photocopy
Please submit one
and one
FILING FEE: $125
SECRETARY OF STATE
payable to
Telephone # ____________________
FAX #
_______________________
1. The name of the limited liability limited partnership is ____________________________________________________
_______________________________________________________________________________________________
The name shall contain the words “Limited Liability Limited Partnership”, or “L.L.L.P.”, or “LLLP” as the last words of the name.
2. The state of its formation_____________________________
3. The date of its formation______________________________
4. The street address of its chief executive office
_______________________________________________________________________________________________
Street Address
City
State
ZIP+4
_______________________________________________________________________________________________
Mailing Address (Optional)
City
State
ZIP+4
5. The South Dakota Registered Agent name ____________________________________________________________
_______________________________________________________________________________________________
Street Address or Rural Route Box Number in This State and
City
State
ZIP+4
_______________________________________________________________________________________________
Mailing Address in This State, if Different from Street Address
City
State
ZIP+4
When listing a Commercial Registered Agent, please state their CRA #.
This number can be obtained from the Commercial Registered Agent.
________________________________
6. The deferred effective date of the registration if it is not to be effective upon filing of the registration
_____________________________________________