Form Llc-5.40 - Illinois Limited Liability Company Act - Illinois Secretary Of State - 1999
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1Illinois
LLC-5.40
This space for use by
Form
Secretary of State
Limited Liability Company Act
January 1999
APPLICATION FOR WITHDRAWAL – DOMESTIC
Jesse White
Secretary of State
Department of Business Services
Limited Liability Company Division
Submit in Duplicate
Room 359, Howlett Building
Must be typewritten
Springfield, IL 62756
This space for use by Secretary of State
Date
Payment may be made by business
Assigned File #
firm check payable to Secretary of
Filing Fee
$100
State. (If check is returned for any
Approved:
reason this filing will be void.)
1. Limited Liability Company name: _________________________________________________________________
____________________________________________________________________________________________
2. File number assigned by the Secretary of State: _____________________________________________________
3. Federal Employer Identification Number (F.E.I.N.): ___________________________________________________
4. The company made an original filing of its Articles of Organization with Secretary of State on __________________
with an effective date of _____________________ and now wishes to withdraw that filing per Section 5-40(b).
5. The undersigned affirms, under penalties of perjury, having authority to sign hereto, that this application for withdrawal
is to the best of my knowledge and belief, true, correct and complete.
Dated ______________________________ , _____.
(Month & Day)
(Year)
______________________________________________
(Signature)
______________________________________________
(Type or print Name and Title)
______________________________________________
(If applicant is a company or other entity, state name of company
and indicate whether it is a member or manager of the LLC.)
LLC-12.2
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