Form Lp 210 - Annual Report Form For Limited Partnership Page 2
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2Form LP 210
I affirm that any entity serving as a General Partner for this Limited Partnership is in good standing in its home
state. The undersigned affirms, under penalties of perjury, that the facts stated herein are true. The Annual
Report must be signed by a General Partner.
Signature
Name & Title (type or print)
General Partner Name if a corporation or other entity (must be in good standing)
Signatures must be in black ink on an original document.
Printed by authority of the State of Illinois. CLP 12.9 — January 2008 — 200
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