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Form August 2008
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LLC-5.47
Illinois Limited Liability Company Act
FILE #:
This space for use by Secretary of State.
Secretary of State Department of Business Services Limited Liability 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.
Statement of Correction
SUBMIT IN DUPLICATE. Must be typewritten.
This space for use by Secretary of State.
Date: Filing Fee: Approved: $25
1. Limited Liability Company Name: __________________________________________________________________ 2. State or Country of Organization: __________________________________________________________________ 3. Title of Document to be Corrected: _________________________________________________________________ 4. Date erroneous Document filed by Secretary of State: _________________________________________________ 5. Inaccuracy, Error or Defect:
(Briefly identify the error and explain how it occurred. If more space is needed, use reverse side or attach additional sheets of this size.)
6. Corrected portion(s) of Document in corrected form:
(If more space is needed, use reverse side or attach additional sheets of this size.)
7. I affirm, under the penalties of perjury, having the authority to sign hereto, that this Statement of Correction 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 whether it is a member or manager of the LLC.
Printed on recycled paper. Printed by authority of the State of Illinois. September 2008 -- 1M -- LLC 34.1