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LP 117
Illinois
FILE #
Form
Uniform Limited Partnership Act
This space for use by Secretary of State.
August 2012
Affidavit of Compliance for
Secretary of State
Department of Business Services
Service on Secretary of State
Limited Liability Division
501 S. Second St., Rm. 357
Springfield, IL 62756
SUBMIT IN DUPLICATE
217-524-8008
Please type or print clearly.
Payment may be made by check
Filing Fee: $50
payable to Secretary of State. If check
is returned for any reason this filing
Approved:
will be void.
Please do not send cash.
1. Name of Limited Partnership being served: ____________________________________________________________
2. Title of Case and Case Number:
_____________________________ First Named Plaintiff
v.
Number_________________________
_____________________________ First Named Defendant
3. Title of Court in which an action, suit or proceeding has been commenced:
____________________________________
4. Title of Instrument being served: ______________________________________________________________________
5.
The Limited Parnership has failed to appoint or maintain an agent for service of process in this State or the agent for service of
process and cannot with reasonable diligence be found. This is the basis for service upon the Secretary of State as agent
of the limited partnership or foreign limited partnership upon whom process, notice or demand is served.
6. Address to which the affiant will send a copy of this instrument by registered or certified mail:
________________________________________________________________________________________________
Street
City, State, ZIP
7. A Copy of the Process, Notice or Demand, together with any papers required by law to be delivered with service, is hereby
attached.
The undersigned affirms, under penalties of perjury, that the facts stated herein are true, correct and complete.
Return to:
Dated: ________________________________________
Month, Day, Year
______________________________________
__________________________________________________
Signature of Affiant
Name (type or print)
______________________________________
__________________________________________________
Name (type or print)
Street Address
______________________________________
__________________________________________________
Street Address
City, State, ZIP
__________________________________________________
City, State, ZIP
__________________________________________________
Daytime Telephone Number
This affidavit will be stamped with the date of filing and returned to the affiant as the only
proof of filing.
♻ Printed on recycled paper. Printed by authority of the State of Illinois. August 2012 — 1 — C LP 2.10