Form Llc-45.40 Illinois Limited Liability Company Act Application For Withdrawal
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1Illinois
LLC-45.40
Form
Limited Liability Company Act
FILE #
December 2004
Application for Withdrawal
Secretary of State Jesse White
This space for use by Secretary of State.
Department of Business Services
Print
Reset
SUBMIT IN DUPLICATE
Limited Liability Division
Must be typewritten
Room 351 Howlett Building
501 S. Second St.
This space for use by Secretary of State.
Springfield, IL 62756
Payment may be made by business
Filing Fee: $ 100
firm check payable to Secretary of State.
(If check is returned for any reason this
Approved:
filing will be void.)
1. Limited Liability Company name: __________________________________________________________________
_____________________________________________________________________________________________
2. Federal Employer Identification Number (F.E.I.N.): ____________________________________________________
3. State or country of organization: __________________________________________________________________
4. Street address to which may be mailed a copy of any process against the company that may be served on the Secretary
of State:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
5. The company is not transacting business in Illinois.
6. The company surrenders its admission to transact business in Illinois.
7. 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.
8. 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 indicate
whether it is a member or manager of the LLC.
Printed by authority of the State of Illinois. February 2005 –2M – LLC-10.3
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