Form Lld-10 - Application For Reinstatement Of A Revoked Or Adminstratively Dissolved Limited Liablity Company January 2009 Page 2
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1
2Limited Liability Company or Professional Limited Liability Company
DUE DATE: April 1, 2008
Companies that do not file their annual reports by the due date are at risk of being assessed monetary penalties and/or
being administratively dissolved or revoked. Complete each section. (Please Print or Type Information)
1.
Name of LLC or PLLC: ________________________________________________________________________
2.
Organization or Qualification date: __________________ In which State: ____________________________
3.
Tax ID #_______________________County Code: _________ Business Class Code: ____________________
To view a list of County Codes they are available at:
To view a list of Business Class Codes they are available at:
4.
Principal Office Address: ________________________________________________________________________
(if different, please make
appropriate changes)
_________________________________________________________________________
_________________________________________________________________________
5.
Designated Office Address
in WV, if any
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
6.
Name and mailing address of the person
to whom notice of process may be sent:
___________________________________________________________
(if different, please make
appropriate changes)
___________________________________________________________
___________________________________________________________
*If new agent furnish new agent’s signature: ____________________________________________________________
7.
Business email address to whom
correspondence may be sent, if any, is:
____________________________________________________________
8.
Manager Information: Complete this section only, if you were set up as a manager-managed company. List the name
and address of each manager having authority to sign filings (attach additional pages if necessary):
Name
Mailing Address
Manager________________________________
____________________________________________________
Manager____________________________
_________________________________________________________
9.
Member Information: Complete this section only, if you were set up as a member-managed company. List the name
and address of each member having authority to sign filings (attach additional pages if necessary):
Member________________________________
____________________________________________________
Member________________________________
____________________________________________________
Member ________________________________
___________________________________________________
Member ________________________________
____________________________________________________
8.
Report must be signed in the name of the company by a: (1) manager of a manager-managed company or (2)
member of a member-managed company.
Signature: _____________________________________________ Date Signed: ____________________________
Title/Capacity of Person Signing: __________________________ Telephone #: ____________________________
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