Statement Of Amendment
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Illinois
FORM
FILE #:
Uniform Partnership Act
UP - mendment
(1001(h)/1102(g))
October 2014
Statement of Amendment
This space for use by Secretary of State.
Secretary of State
Department of Business Services
SUBMIT IN DUPLICATE
Limited Liability Division
501 S. Second St., Rm. 357
Type or Print Clearly.
Springfield, IL 62756
217-524-8008
Filing Fee:
$25
Payment may be made by check pay-
Approved:
able to Secretary of State. If check is
returned for any reason this filing
will be void.
Federal Employer Identification Number (F.E.I.N.):____________________________________________________
1. Partnership Name: ________________________________________________________________________
2. State of Jurisdiction: ______________________________________________________________________________________________________
3. The Statement of Qualification is amended as follows: (Check all applicable changes and specifiy them in
item 4 below.) (For address changes — P.O. Box alone is unacceptable.)
o a) Change of registered agent and/or registered agent’s office (give new name/address in item 4a) Must be
an Illinois resident/company.
o b) Change in address of chief executive office (give new address in item 4b)
o c) Change in number of partners (give change of number of partners in item 4c) (Attach current list of
partners.) (Total number of partners and number of Illinois partners.)
o d) Change in Limited Liability Partnership name (give name change in item 4d) (Certified copy of
Amendment From Domicile State required.)
o e) Change in partner’s name/address (give name/address change in item 4e)
o f) Other (give information in item 4f)
4. List all changes from item 3.
a) ____________________________________________________________________________________
b) ____________________________________________________________________________________
c) ____________________________________________________________________________________
d) ____________________________________________________________________________________
e) ____________________________________________________________________________________
f) ____________________________________________________________________________________
Printed by authority of the State of Illinois. November 2014 — 1 — UPA 14.4
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