Form Llc-50.1 - Annual Report
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Illinois Limited Liability Company Act
L.L.C. File #: ________________________________
Annual Report
Filing Deadline is Prior to: ______________________
Type or print clearly.
This report must be submitted to the Office of the Secretary
Filing Fee: $250
of State prior to the anniversary date to avoid late filing, penalty
or eventual administrative dissolution or revocation.
Penalty:
LLC-50.1
Form
April 2010
Total:
1. Limited Liability Company Name:
Registered Agent, Registered Office, City, IL, ZIP Code
FILE THIS REPORT ONLINE:
2. State or Country of Organization: ________________________ Date Organized in or Admitted to Illinois: _____________
3. Address of Principal Place of Business: (P.O. Box alone is unacceptable.)
Number
Street
Suite
City, State
ZIP Code
4. Names and Addresses of Managers or, if none, the Members:
Name
Number & Street
City, State
ZIP Code
Select One:
MGR/MBR
____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
________________________________________________________________________________________________________________
5. The managers/members who are entities affirm that existence is still intact.
6. Changes to the registered agent or address in Item 1 above require the filing of Form LLC-1.36/1.37.
7. I affirm, under penalties of perjury, having authority to sign thereto, that this Annual Report is to the best of my knowledge and
belief, true, correct and complete.
Dated: ____________________________ , ___________
Month/Day
Year
A late filing penalty of $300 will apply if this report
is not filed within 60 days after the due date. Make
check payable to Secretary of State. If check is
returned for any reason this filing will be void.
Signature
SECRETARY OF STATE
Name and Title of Manager or Member (type or print)
Department of Business Services
Limited Liability Division
501 S. Second St., Rm. 351
If applicant is a company or other entity, state Name of Company
217-524-8008
and indicate whether it is a member or manager of the LLC.
Springfield, IL 62756
Printed by authority of the State of Illinois. June 2010 — 3M — LLC 23.8
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