Free Reinstatement following Administrative Dissolution - Illinois

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LLC-35.40/ 45.65

Illinois Limited Liability Company Act
Application for Reinstatement Following Administrative Dissolution or Revocation
SUBMIT IN DUPLICATE Must be typewritten.
This space for use by Secretary of State.

FILE #:
This space for use by Secretary of State.

August 2008

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 must be made by certified check, cashier's check, Illinois attorney's check, Illinois C.P.A.'s check or money order payable to Secretary of State.

Date: Filing Fee: $500 Approved:

1. Limited Liability Company Name as of the date of issuance of Notice of Dissolution or Revocation: ____________________________________________________________________________________________ If applicable, New Name of Limited Liability Company (Form LLC 5.25 or LLC 45.25 must accompany this application): ____________________________________________________________________________________________ 2. State of Organization: ___________________________________________________________________________ 3. Date Notice of Dissolution or Revocation issued: _______________________________________________________ 4. Registered Agent: __________________________________________________________________________
First Name Middle Initial Last Name

Registered Office: __________________________________________________________________________ Number Street Suite # (P.O. Box and c/o are unacceptable) __________________________________________________________________________
City ZIP Code County

This application is accompanied by all amendments necessary to change, add or remove an existing provision, by all delinquent reports, information requirements and registrations due and therefore becoming due, together with all fees and penalties required. I affirm under penalties of perjury, having authority to sign hereto, that this application for reinstatement 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 8.5