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LLC-35.40/
Illinois
FILE #
Form
Limited Liability Company Act
45.65
This space for use by Secretary of State.
May 2012
Application for Reinstatement Following
Secretary of State
Administrative Dissolution or Revocation
Department of Business Services
SUBMIT IN DUPLICATE
Limited Liability Division
501 S. Second St., Rm. 351
Typed or Print Clearly
Springfield, IL 62756
217-524-8008
This space for use by Secretary of State.
Filing Fee: $500
Total payment must be made by
certified check, cashier’s check,
Approved:
Illinois attorney’s check, Illinois
C.P.A.’s check or money order
payable to Secretary of State.
1. Limited Liability Company Name as of the date of issuance of Notice of Dissolution or Revocation:
______________________________________________________________________________________________
2. If applicable, New Name of Limited Liability Company (Form LLC 5.25 or LLC 45.25 must accompany this application):
______________________________________________________________________________________________
3. State of Organization: ____________________________________________________________________________
4. Date Notice of Dissolution or Revocation issued: __________________________________________________________
5. Registered Agent:
______________________________________________________________________________
First Name
Middle Initial
Last Name
Registered Office:
______________________________________________________________________________
Number
Street
Suite #
(P.O. Box and
IL
c/o are unacceptable)
______________________________________________________________________________
City
ZIP Code
Note: If the Registered Agent and/or Office Address has changed since dissolution or revocation, complete form LLC 1.36/1.37
and submit with this application.
This application is accompanied by all amendments necessary to change, add or remove an existing provision, by all delinquent
reports, information requirements and registrations due and therefore becoming due, together with all fees and penalties required.
I affirm under penalties of perjury, having authority to sign hereto, that this application for reinstatement 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 whether it is a member or manager of the LLC.
Printed by authority of the State of Illinois. May 2012 — 1 — LLC 8.9