Free ss-4240.indd - Tennessee

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Corporate Filings 312 Rosa L. Parks Avenue 6th Floor, William R. Snodgrass Tower Nashville, TN 37243

APPLICATION FOR REINSTATEMENT FOLLOWING ADMINISTRATIVE DISSOLUTION/REVOCATION (LLC)

Pursuant to the provisions of §48-245-303 or §48-246-503 of the Tennessee Limited Liability Company Act or §48-259-606 or §48-249-910 of the Tennessee Revised Limited Liability Company Act, this application is submitted to the Tennessee Secretary of State for reinstatement. 1. The name of the Limited Liability Company is (Name change if applicable)

2. The effective date of its administrative dissolution/revocation is (must be month, day and year) 3. The ground(s) for the administrative dissolution/revocation did not exist. has/have been eliminated. [NOTE: Please mark the applicable box] 4. The Limited Liability Company name as listed in number one (1) satisfies the name requirements of Tennessee Limited Liability Company Act or Tennessee Revised Limited Liability Company Act, as applicable. 5. The Limited Liability Company control number assigned by the Secretary of State, if known is

.

Signature Date

Name of Limited Liability Company

Signer's Capacity

Signature

Name (typed or printed)

SS-4240 (Rev. 01/06)

Filing Fee: $70.00

RDA 2458