Form D - Foreign Limited Liability Company Application For Reinstatement Following Administrative Dissolution Form - The Commonwealth Of Massachusetts Page 2

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COMMONWEALTH OF MASSACHUSETTS
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Boston, Massachusetts 02108-1512
Foreign Limited Liability Company
Application for Reinstatement
Following Administrative Revocation
(General Laws Chapter 156C Section 71)
I hereby certify that upon examination of this application for reinstatement, duly
submitted to me, it appears that the provisions of the General Laws relative thereto
have been complied with, and I hereby approve said application; and the filing fee in
the amount of $______ having been paid, said application is deemed to have been
filed with me this day of ______________20_______ at _______a.m./p.m.
time
Effective date: ____________________________________________ ________
(must be within 90 days of date submitted)
WILLIAM FRANCIS GALVIN
Examiner
Secretary of the Commonwealth
Name approval
Filing fee: $100
#A.R.
TO BE FILLED IN BY
FOREIGN LIMITED LIABILITY COMPANY
Contact Information:
___________________________________________________________
___________________________________________________________
___________________________________________________________
Telephone: ___________________________________________________
Email: ______________________________________________________
Upon filing, a copy of this filing will be available at
If the document is rejected, a copy of the rejection sheet and rejected document will
be available in the rejected queue.

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