Form Cr2e041,1/14-Limited Liability Company Reinstatement-Florida Department Of State-

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LIMITED LIABILITY

FLORIDA DEPARTMENT OF STATE

Secretary of State

COMPANY

REINSTATEMENT

DIVISION OF CORPORATIONS

DOCUMENT #

Limited Liability Company’s Name

CR2E041 (1/14)

Principal Office Address - No P.O. Box #

Mailing Office Address

State/Country of Formation

Suite, Apt. #, etc.

Date Organized or Qualified

To Do Business in Florida

City & State

Applied For

FEI Number

Not Applicable

Zip

Country

Zip

Country

$5.00

Additional Fee required

CERTIFICATE OF STATUS DESIRED

for a Certificate of Status

Name and Address of Current Registered Agent

Name

Street Address (P.O. Box Number is Not Acceptable)

Suite, Apt. #, Etc.

City

State

Zip Code

I, being appointed the registered agent of the above named limited liability company, am familiar with and accept the obligations of Chapter 605, F.S.

Signature of

Registered Agent

Date

REGISTERED AGENT MUST SIGN

10.

Names and Street Addresses of Authorized Representatives/Managers

Name of

Street Address of Each

Titles

City / State / Zip

Authorized Representatives/

Authorized Representative/

Managers

Manager

11.

E-mail Address:

(To be used for future annual report notifications)

12.

I certify that I am an authorized representative/manager or the receiver or trustee empowered to execute this application as provided for in Chapter 608, F.S. I further certify that

when filing this reinstatement application the reason for dissolution has been eliminated, the limited liability company name satisfies the requirements of section 605.0012. F.S., and

that all fees owed by the limited liability company have been paid. The information indicated on this application is true and accurate, and my signature shall have the same legal effect

as if made under oath. I am aware that false information submitted to the Department of State constitutes a third degree felony as provided in s. 817.155, F.S.

Signature of

Authorized Representative/ Manager

Date

Daytime Phone #

Typed or printed name of signing Authorized Representative/ Manager