Free Application for Admission to Transact Business - Illinois

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LLC-45.5

Illinois Limited Liability Company Act

November 2008

Secretary of State Jesse White 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.

Application for Admission to Transact Business
SUBMIT IN DUPLICATE Must be typewritten.
This space for use by Secretary of State.

FILE #
This space for use by Secretary of State.

Filing Fee: $500 Penalty: Approved: $

1.

Limited Liability Company Name:___________________________________________________________________
Must comply with Section 1-10 of ILLCA or Item 2 below also applies.

2.

Assumed Name: _________________________________________________________________________________
By electing this Assumed Name, the Limited Liability Company hereby agrees not to use its Company Name in the transaction of business in Illinois. Form LLC-120 is attached.

3.

Jurisdiction of Organization:_______________________________________________________________________

4.

Date of Organization:_____________________________________________________________________________

5. 6.

Period of Duration:_______________________________________________________________________________ Address, including County, of the Office required to be maintained in the jurisdiction of its organization or, if not required, of the Principal Place of Business: (P.O. Box alone or c/o is unacceptable.) _____________________________________________________________________________________________
Number Street Suite #

_____________________________________________________________________________________________
City/State ZIP Code County

7.

Registered Agent:_______________________________________________________________________________
First Name Middle Name Last Name

Registered Office:________________________________________________________________________________ Number Street Suite # (P.O. Box alone or c/o is unacceptable.) Illinois _______________________________________________________________________________
City County ZIP Code

8.

If applicable, Date on which Company first conducted business in Illinois: __________________________________

(continued on back)

Printed by authority of the State of Illinois. November 2008 -- 1 -- LLC-17.10

LLC-45.5
9. Purpose(s) for which the Company is Organized and Proposes to Conduct Business in Illinois: (Include Business Code # from IRS Form 1065.) _________________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ _________________________________________________________________________________________ 10. The Limited Liability Company: (check one) is managed by a manager or managers (List names and business addresses.)

has management vested in the member or members (List names and addresses.)

11. The Illinois Secretary of State is hereby appointed the agent of the Limited Liability Company for service of process under the circumstances set forth in subsection (b) of Section 1-50 of the Illinois Limited Liability Company Act. 12. This application is accompanied by a Certificate of Good Standing or Existence, as well as a copy of the Articles of Organization, as amended, duly authenticated within the last 60 days, by the officer of the state or country wherein the LLC is formed. 13. If the period of duration is a date certain and is not stated in the Articles of Organization from the domestic state, a copy of that page from the Operating Agreement stating the date also must be submitted. 14. The undersigned affirms, under penalties of perjury, having authority to sign hereto, that this application for admission to transact business is to the best of my knowledge and belief, true, correct and complete.

Dated ________________________________ , _________ .
Month & Day Year

_______________________________________________
Signature (Must comply with Section 5-45 of ILLCA.)

_______________________________________________
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. Please refer to Sections 178.20 of the Administrative Rules.

Printed by authority of the State of Illinois. November 2008 -- 1 -- LLC-17.10