Free Affidavit of Compliance - Illinois

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LLC-1.50

Illinois Limited Liability Company Act

FILE #
This space for use by Secretary of State.

November 2008

Secretary of State Jesse White Department of Business Services Limited Liability Company Division 501 S. Second St., Rm. 351 Springfield, IL 62756 217-524-8008 www.cyberdriveillinois.com Payment may be made by business firm check payable to Secretary of State. If check is returned for any reason this filing will be void.

Affidavit of Compliance for Service on Secretary of State
Submit in Duplicate Must be typewritten.
This space for use by Secretary of State.

Date: Filing Fee: $100 Approved:

1. Name of Limited Liability Company being served: _____________________________________________________ ____________________________________________________________________________________________ 2. Title of Case and Case Number: __________________________________ v. __________________________________ First Named Plaintiff Number: __________________________ First Named Defendant

3. Title of Court in which an action, suit or proceeding has been commenced: _________________________________ 4. Title of Instrument being served:__________________________________________________________________ . 5. A Copy of the Process, Notice or Demand, together with any papers required by law to be delivered with service, are hereby attached. 6. Address to which the undersigned has caused a copy of the attached Process, Notice or Demand to be sent by certified or registered mail: _____________________________________________________________________________ ____________________________________________________________________________________________ 7. Basis for service on the Secretary of State (check and complete appropriate box): a. The Limited Liability Company's registered agent cannot with reasonable diligence be found at the registered office in Illinois. b. The Limited Liability Company has failed to appoint and maintain a registered agent in Illinois. c. The Limited Liability Company was dissolved on _________ , _____ ; the conditions of paragraphs (a) and (b)
Month & Day Year



above exist; and the action, suit or proceeding has been instituted or has affected the Limited Liability Company within 5 years thereafter. d. The Limited Liability Company's application for admission to transact business in Illinois has been withdrawn or revoked on _________ , _____ .
Month & Day Year

e. The Limited Liability Company is a Foreign Limited Liability Company which has transacted business in Illinois without having lawfully been admitted to do so, contrary to the provisions of the Illinois Limited Liability Company Act of 1992. (continued on back)

Printed by authority of the State of Illinois. November 2008 -- 1 -- LLC-13.4

LLC-1.50 8. The undersigned affirms, under penalties of perjury, that the facts stated herein are true.

__________________________________________
Signature of Affiant

_________________________________ , _______ .
Month & Day Year

( ) _______________________________________________
Telephone Number

RETURN TO: PLEASE TYPE OR PRINT CLEARLY ______________________________________
Name

______________________________________
Street

______________________________________
City, State, ZIP

Printed by authority of the State of Illinois. November 2008 -- 1 -- LLC-13.4