State Form 4160 - Application For Reinstatement
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SECRETARY OF STATE
APPLICATION FOR REINSTATEMENT
BUSINESS SERVICES DIVISION
State Form 4160 (R15 / 3-17)
302 West Washington Street, Room E018
Approved by State Board of Accounts, 2017
Indianapolis, IN 46204
Telephone: (317) 232-6576
INSTRUCTIONS:
1. Use 8 ½” x 11” white paper for attachments.
2. Please TYPE or PRINT in INK.
3. Please visit our office on the web at
4. Make check or money order payable to the Secretary of State.
5. Submit original completed paperwork and payment to: 302 West Washington Street, Room E-018, Indianapolis, IN 46204.
6. The Application for Reinstatement must include the following:
Certificate of Clearance issued by the Indiana Department of Revenue
Business Entities Reports for all outstanding years due
7. A Series cannot apply for reinstatement for the Master LLC. The Application for Reinstatement must be submitted
by the Master LLC.
NOTE:
This application for reinstatement cannot be accepted without a Certificate of Clearance for reinstatement from the
Indiana Department of Revenue.
INFORMATION CONTAINED ON THIS PAGE IS NOT PART OF THE PUBLIC RECORD.
Name of business
E-mail address of business (SOS use only)
RETURN DOCUMENTS TO:
Name
Street address, line 1
Street address, line 2
City
State
ZIP code
Telephone number
E-mail address (If different from above – SOS use only)
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