Form Llc-35.40/ 45.65 - Application For Reinstatement Following Administrative Dissolution Or Revocation

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LLC-35.40/
Illinois
Form
Limited Liability Company Act
FILE #:
45.65
Application for Reinstatement Following
August 2008
Administrative Dissolution or Revocation
Secretary of State
This space for use by Secretary of State.
Department of Business Services
Limited Liability Division
SUBMIT IN DUPLICATE
501 S. Second St., Rm. 351
Must be typewritten.
Springfield, IL 62756
217-524-8008
This space for use by Secretary of State.
Date:
Payment must be made by certified check,
Filing Fee: $500
cashier's check, Illinois attorney's check,
Illinois C.P.A.'s check or money order
Approved:
payable to Secretary of State.
1. Limited Liability Company Name as of the date of issuance of Notice of Dissolution or Revocation:
____________________________________________________________________________________________
If applicable, New Name of Limited Liability Company (Form LLC 5.25 or LLC 45.25 must accompany this
application):
____________________________________________________________________________________________
2. State of Organization: ___________________________________________________________________________
3. Date Notice of Dissolution or Revocation issued: _______________________________________________________
4. Registered Agent:
__________________________________________________________________________
First Name
Middle Initial
Last Name
Registered Office:
__________________________________________________________________________
Number
Street
Suite #
(P.O. Box and
c/o are unacceptable) __________________________________________________________________________
City
ZIP Code
County
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 on recycled paper. Printed by authority of the State of Illinois. September 2008—1M—LLC 8.5

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