This form must be type written or computer generated.
              State of Utah 
              Department of Commerce 
              Division of Corporations & Commercial Code 
              Foreign   Registration Statement (Limited Liability Partnership) 

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Instructions
Important: Read instructions before completing form.                                              Non-Refundable Processing Fee: $70.00 
1. Limited Liability Partnership name:
 ___________________________________________________________________________________________________
                      (Name of Limited Liability Partnership in the Home State – see instructions for name requirements) 
2. Jurisdiction of qualification:
3. Principal office address:                    _______________________________________________________________________________________ 
   Street Address Required                      Address      City  State          Zip
4. The name of the Registered Agent (Individual or Business Entity or Commercial Registered Agent):
________________________________________________________________________________________
The  address must be listed if you have a non-commercial registered agent.  See instructions for further details.  
Address of the Registered Agent: ___________________________________________________________ 
                                            Utah Street Address Required, PO Boxes can be listed after the Street Address 
City:                                                                                                    State  UT         Zip:
5a.  Partner Name & Address:                    Name:    _________________________________________________________ 
(Partners are optional)  
                                                __________________________________________________________ 
                                                Street Address 
                                                _______________________________________________________________________________________ 
                                                City                                                                    State                    Zip 

5b.  Partner Name & Address:                    Name:    _________________________________________________________ 
(Partners are optional)  
                                                __________________________________________________________ 
                                                Street Address 
                                                _______________________________________________________________________________________ 
                                                City                                                                    State                     Zip 
6. The Limited Liability Partnership shall use as its name in Utah:
___________________________________________________________________________________________
                                   Must be the same as number (1) unless the name is not available or permitted in Utah.
7. Under penalties of perjury and as an authorized partner, I declare that this application, and if applicable, the statement of change of
registered office and/or agent, has been examined by me and is, to the best of my knowledge and belief, true, correct, and complete.
Authorized Signer Signature:       Sign here after the form is printed      Name & Title:
8. Purpose of the Limited Liability Partnership:
   (optional) 
Under GRAMA {63G-2-201}, all registration information maintained by the Division is classified as public record.  For confidentiality purposes, 
you may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity. 
Optional Inclusion of Ownership Information:  This information is not required.  
Is this a female owned business?            Yes                     No 
Is this a minority owned business?          Yes                     No       If yes, please specify:  Select/Type the race of the owner here

Mailing/Faxing Information:    www.corporations.utah.gov/contactus.html             Division's Website:                 www.corporations.utah.gov

06/22