Free LLC 10.4 app for withdraw - Illinois

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LLC-45.40

July 2008

Illinois Limited Liability Company Act
Application for Withdrawal
SUBMIT IN DUPLICATE. Must be typewritten.
This space for use by Secretary of State.

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

Secretary of State Department of Business Services Limited Liability Division 501 S. Second St., Room 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.

Filing Fee: $ 100 Approved:

1. Limited Liability Company Name: __________________________________________________________________ _____________________________________________________________________________________________ 2. State or Country of Organization: __________________________________________________________________ 3. Street Address to which a copy of any process against the company served on the Secretary of State may be mailed: _____________________________________________________________________________________________ _____________________________________________________________________________________________ 4. The company is not transacting business in Illinois. 5. The company surrenders its admission to transact business in Illinois. 6. The company revokes the authority of its registered agent in Illinois and consents that service of process may hereafter be made on the company by service thereof upon the Secretary of State. 7. 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 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 10.4