Form Llc-50.1(F) - Foreign Limited Liability Company Annual Report

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Jesse White
L.L.C. File Number: ________________________
Secretary of State – State of Illinois
Foreign Limited Liability Company
Filing Deadline is Prior to : __________________
Annual Report
This report must be RECEIVED in the office of the Secretary
of State prior to the anniversary date to avoid late filing penalties
$250 Filing Fee
and eventual administrative revocation of its admission.
LLC-50.1(F)
Form
December 2003
Must be typewritten
1. Limited Liability Company name:
Registered Agent, Registered Office, City, IL., ZIP Code
Print
Reset
2. State or Country of Organization: ____________________________ Date admitted into Illinois: _____________
3. Address of the office at which the records required by Section 1-40 are to be kept is:
(Number)
(Street)
(Suite)
(City, State)
(ZIP Code)
(County)
4. Names and addresses of the managers or, if none, the members:
Name
Number & Street
City, State
ZIP Code
Select One:
MGR/MBR
____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
5. The mgrs/mbrs, which are entities, affirm the evidence of existence on file with the Illinois Secretary of State is still intact.
6. 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 ____________________________ , ___________ .
Payment may be made by business firm
(Month/Day)
(Year)
check payable to Secretary of State. (If
check is returned for any reason this filing
will be nullified.)
(Signature)
Return to:
(Type or print Name and Title of Mgr. or Mbr.)
JESSE WHITE
SECRETARY OF STATE
Department of Business Services
(If applicant is a company or other entity, state name of company
Limited Liability Company Division
and indicate whether it is a member or manager of the LLC.)
Room 351, Howlett Building
Springfield, IL 62756
LLC-23.3

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