Free Illinois Limited Liability Company Act Penalty - Return to Good Standing - Illinois

Print
Form

Reset

LLC-50.15

July 2005

Illinois Limited Liability Company Act
Penalty - Return to Good Standing
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 Jesse White Department of Business Services Limited Liability Division Room 351 Howlett Building 501 S. Second St. Springfield, IL 62756 www.cyberdriveillinois.com Payment must be made by certified check, cashier's check, Illinois attorney's C.P.A.'s check or money order payable to Secretary of State.

Filing Fee: Approved:

1. Limited Liability Company Name:________________________________________________________________ _____________________________________________________________________________________ 2. Penalties applicable to return the Limited Liability Company to good standing: (check and complete where appropriate) a) $300 Failure to file the annual report and pay the requisite fee prior to the first day of the anniversary month. b) $300 Failure to appoint and maintain a registered agent in Illinois as required. c) $100 For each year or fraction thereof beginning with the second year of deliquency until the filing of this document. Total penalty amount (a, b and c): $ ____________________ 3. I affirm, under penalties of perjury, having authority to sign hereto, that this penalty form 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. July 2005 ­5M ­ LLC-7.6