Free Application for Withdrawal-Domestic - Illinois

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LLC-5.40

Illinois Limited Liability Company Act

FILE #
This space for use by Secretary of State.

January 1999

Secretary of State Jesse White Department of Business Services Limited Liability Company Division 501 S. Second St., Rm. 351 Springfield, IL 62756 217-524-9008 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.

Application for Withdrawal -- Domestic
Submit in Duplicate Must be typewritten.
This space for use by Secretary of State.

Date: Filing Fee: $100 Approved:

1. Limited Liability Company Name: __________________________________________________________________ ____________________________________________________________________________________________ 2. File Number assigned by Secretary of State: _________________________________________________________ 3. Federal Employer Identification Number (F.E.I.N.): ____________________________________________________ 4. The company made an original filing of its Articles of Organization with the Secretary of State on ________________
Date

with an effective date of _____________________, and now wishes to withdraw that filing per Section 5-40(b).

5. The undersigned affirms, under penalties of perjury, having authority to sign hereto, that this application for withdrawal is to the best of my knowledge and belief, true, correct and complete. Dated ______________________________ , _____.
Month & Day Year

______________________________________________
Signature

______________________________________________
Name and Title (type or print)

______________________________________________
If applicant is a Company or other Entity, state Name of Company and indicate whether it is a member or manager of the LLC. Printed by authority of the State of Illinois. April 2007 -- 500 -- LLC 12.3