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Illinois
FILE #
LLC-1.15
Limited Liability Company Act
Form
a) Application to Reserve a Name
This space for use by Secretary of State.
May 2012
b) Transfer of Reserved Name
Secretary of State
c) Cancellation of Reserved Name
Department of Business Services
Limited Liability Division
SUBMIT IN DUPLICATE
501 S. Second St., Rm. 351
Type or print clearly.
Springfield, IL 62756
217-524-8008
This space for use by Secretary of State.
Filing Fee: a) $300 b) $100 c) $100
Payment may be made by check
Approved:
payable to Secretary of State. If
check is returned for any reason this
filing will be void.
APPLICATION TO RESERVE A NAME
a) Limited Liability Company Name to be reserved: ________________________________________________________
_______________________________________________________________________________________________
The LLC name must contain the words “Limited Liability Company”, L.L.C. or LLC and cannot contain the terms Corporation, Corp., Incorporated, Inc.,
Ltd., Co., Limited Partnership, or L.P.
Name of Applicant: _________________________________________________________________________________
Address of Applicant: ________________________________________________________________________________
The undersigned hereby applies for reservation of the above listed Limited Liability Company name for a period of 90 . .
days. This document is optional and, once filed, it does not establish a Limited Liability Company.
Dated ________________________, _______.
_____________________________________________
Month & Day
Year
Signature of Applicant
_____________________________________________
Name and Title (type or print)
_____________________________________________
If applicant is a Company or other Entity, state Name of Company.
NOTICE OF TRANSFER OF RESERVED NAME
b) The undersigned __________________________________ hereby transfers to_______________________________
Name of Transferee
Name of Original Applicant
_____________________________________ the right to use the name ________________________________ for LLC
Address of Transferee
purposes in Illinois. This name was reserved on ____________________________ , _______ .
Year
Month & Day
The undersigned affirms, under penalties of perjury, that the facts stated herein are true.
Dated ________________________, _______.
_____________________________________________
Month/Day
Year
Signature of Original Applicant
_____________________________________________
Name and Title (type or print)
_____________________________________________
If applicant is a Company or other Entity, state Name of Company.
Printed by authority of the State of Illinois. May 2012 — 1 — LLC 16.7