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Arizona Department of State Office of the Secretary of State , Secretary of State State of Arizona Office of the Secretary of State Statement of Domesticati on , A.R.S. 247 29 - 2 5 05 SEND BY MAIL TO: Secretary of State , Atten: Limited Partnerships1700 W. Washington Street, FL. 7, Phoenix, AZ 85007-2808 O R return this application in person: PHOENIX - State Capitol Executive Tower, 1700 W. Washington Street, Fl., TUCSON - Arizona State Complex , 400 W. Congress , 1st Fl., Suite 14 1 Office Hours: Monday through Friday, 8 a.m. to 5 p.m., except state holidays. D O N OT W RITE IN T HIS S PACE FOR OFFICE USE ONLY SOSBS ARS292505 REV. //201 PLEASE NOTE: All correspondence regarding this filing will be sent to the principal office identified on this certificate. This application must be submitted with a self - addressed, stamped envelope with applicable filing fees. 1. Domestica ting Entity Information Domesticat ing Entity Name Jurisdiction of Organization Secretary of State file number, if any Entity Type (select one) Corporation Limited Liability Company Partnership Other: 2. Domestica ted Entity Information Domesticated Entity Name Jurisdiction of Organization Secretary of State file number, if any Domesticated street address in this state City State Zip Surviv i ng Entity Type (select one) : Corporation Limited Liability Company Partnership Other: If the surviving type is a partnership not on record , this form must be attached to a Statement of Qualification. See the instructions for further detail. Delayed effective date and time, if any , but not more than 90 days from date of receipt. See the instructions for further detail. 3. Agent for service of process of foreign entity not required to become a qualified foreign entity Domesticated entity agent for service of process Arizona address of agent for service of process (P.O. Box or C/O are unacceptable) City State AZ Zip 4 . Approved signature of domestica ting entity Name of Signer on behalf of domesticat i ng entity Statement of Domesticati on Approval This domestication was approved by this domestic or foreign domesticating entity. [A.R.S. 247 29 - 2505(B)(4)] Signature Month Day Year Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Arizona Department of State Office of the Secretary of State , Secretary of State State of Arizona Office of the Secretary of State Statement of Domestication Instructions , A.R.S. 247 29 - 2505 SEND BY MAIL TO: Secretary of State , Atten: Limited Partnerships 1700 W. Washington Street, FL. 7, Phoenix, AZ 85007-2808 O R return this application in person: PHOENIX - State Capitol Executive Tower, 1700 W. Washington Street, Fl., TUCSON - Arizona State Complex , 400 W. Congress , 1st Fl., Suite 141 Office Hours: Monday through Friday, 8 a.m. to 5 p.m., except state holidays. DO NOT WRITE IN THIS SPACE FOR OFFICE USE ONLY SOSBS ARS292605 REV. /201 Instruction Be Accurate: Complete all applicable fields on this form. Write legibly; or fill out this application online at www.azsos.gov and print it. Processing: 2-3 weeks; expedited service ()available for an additional $25. Submission: Submit this certificate in duplicate (one original, one copy) with a self-addressed, stamped envelope with payment. Any other matters, please attach additional sheets with filing. Questions? Call (602) 542-6187; in-state/toll-free (800) 458-5842. Filing fee and Payment : $10 + $3 plus $3 per additional page. Checks or mon ey orders shall be made payable to the Secretary of State. This fee is considered per entity name listed on the Statement of Dom estication affect ing any entity(ies) recorded by our office , and not f or filing the Statement of Domestication itself. Statuatory Obligation Arizona Revised Statutes (A.R.S.) 247247 29 - 2 5 01 25 07 provide reference for the creation of and recording of conversions . The requirements for this Statement of Domestication are set forth in A.R.S. 247 29 - 25 05. The filing of this form w ill affect all partnerships with our office. Statement of Domestication Effective Date If no effective date is specified and the filing meets all statutory requirements, the Secretary of State will deem the Statement to be effective on the date of delivery. Should a Statement have an effective date, it must be delivered to our office no more than 90 days ffective date. If the Statement is submitted more than 90 days before the effective date, our office will return the form and detail when the form should be resubmitted. Additional Steps/Requirements Determine if any additional steps must take place. Our office will require additional paperwork , and subsequent fees , if the domesticated entity is a partnership not on file with our office. If additional paperwork and fees are not received, the entire request wi ll be returned for resubmission. Option 1 : Domesticated entity will be filed as a partnership not on fil e. The Statement of Domestication must be submitted with the appropriate registration form below, along with its filing fees. Option 2 : Domesticated entity is a partnership currently on file with our office. Our office will process the Statement of Domestication as an amendment to the existing partnership on file. Option 3 : Domesticated entity is an entity not recorded by our office or is a domesticating entity will become a foreig n entity. Our office will process the Statement of Domestication as a cancellation to the existing partnership on file. 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