Form Llc-5.40 - Application For Withdrawal Domestic
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Illinois
LLC-5.40
Form
Limited Liability Company Act
FILE #
January 1999
Application for Withdrawal —
This space for use by
Secretary of State Jesse White
Secretary of State.
Domestic
Department of Business Services
Limited Liability Company Division
501 S. Second St., Rm. 351
Submit in Duplicate
Springfield, IL 62756
Must be typewritten.
217-524-9008
This space for use by Secretary of State.
Date:
Payment may be made by business
firm check payable to Secretary of
Filing Fee: $100
State. If check is returned for any
Approved:
reason this filing will be void.
1. Limited Liability Company Name: __________________________________________________________________
____________________________________________________________________________________________
2. File Number assigned by Secretary of State: _________________________________________________________
3. Federal Employer Identification Number (F.E.I.N.): ____________________________________________________
4. The company made an original filing of its Articles of Organization with the Secretary of State on ________________
Date
with an effective date of _____________________, and now wishes to withdraw that filing per Section 5-40(b).
5. 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. April 2007 — 500 — LLC 12.3
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