Form Upa-1001 - Illinois Statement Of Qualification Page 2
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26. Total Number of Partners:
7. Names and Mailing Addresses of all Partners:
Name, Street Address, City, State, ZIP
Name, Street Address, City, State, ZIP
Name, Street Address, City, State, ZIP
8. Brief statement of the business in which the partnership engages:
9. The Partnership hereby applies for status as a Limited Liability Partnership.
10. Registration Application is effective on (check one):
a) the filing date
b) another date later than but not more than 60 days subsequent to the filing date:
Month, Day, Year
11. We declare, under the penalty of perjury, under the laws of the State of Illinois, that the foregoing is true,
correct and complete.
Executed on the ___________of _______________ , ___________ by at least two partners.
Day
Month
Year
Signature
Number, Street Address
Name and Title (type or print)
City, State, ZIP
Signature
Number, Street Address
Name and Title (type or print)
City, State, ZIP
Please submit this form in duplicate along with $100 for each partner,
but not less than $200 or more than $5,000, minimum two partners.
Signatures must be in BLACK INK on an original document.
Carbon copy, photocopy or rubber stamp signatures may only be used on conformed copy.
For additional space, continue in the same format on a plain white 8.5x11” sheet of paper.
♻
Printed on recycled paper. Printed by authority of the State of Illinois. June 2010 – 200 – UPA 12.4
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