Certificate Of Reinstatement Limited Liability Company Form

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CERTIFICATE OF REINSTATEMENT
LIMITED LIABILITY COMPANY
MAILING ADDRESS:
DELIVERY ADDRESS:
Commercial Recording Division
Commercial Recording Division
Connecticut Secretary of the State
Connecticut Secretary of the State
P.O. Box 150470
30 Trinity Street
Hartford, CT 06115-0470
Hartford, CT 06106
860-509-6003
860-509-6003
THE CERTIFICATE OF REINSTATEMENT MUST BE FILED WITH A
CURRENT ANNUAL REPORT.
Space For Office Use Only
Filing Fee: $60.00 Make Checks Payable to “Secretary of the State”
Please contact the Department of Revenue Services or your tax advisor as to any potential tax liability relating to your business.
1. NAME OF LIMITED LIABILITY COMPANY
2. APPOINTMENT OF REGISTERED AGENT
(Please select only one A or B)
A. Individual’s Name
Business address (P.O. Box is unacceptable)
Residence address (P.O. Box is unacceptable)
B. Business Entity
Address (P.O. Box is unacceptable)
Acceptance of appointment
_____________________________________________________________
Signature of agent
3. EXECUTION
Dated this _________________day of ____________________, 20______.
Print or type name of signatory
Capacity of signatory
Signature
Rev. 08/23/2007

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