1. Li
m
i
ted Li
abi
l
i
ty
Com
pany
nam
e:
_________
___________________________________________________________
2.
A
ddr
es
s
of pr
i
nc
i
pal
pl
ac
e of bus
i
nes
s
:
_____
___________________________________________________________
____
_______________________________
_______________________________
____________________________
3. State name of a member, manager or other person and the authority or the limitations on authority regarding the
execution of an instrument transferring real property held in the name of the company or other actions that bind the
company:
____
_______________________________
_______________________________
____________________________
____
_______________________________
_______________________________
____________________________
____
_______________________________
________________________________
___________________________
4. If applicable, the filing of this statem
ent cancels or
am
ends a statem
ent in ef
fect.
File date or
ef
fective date of or
iginal statem
ent:
________
__________________________,
____________________
Descr
iption of the am
endm
ent or
a declar
ation the statem
ent is canceled:
____________________
______________________________________________________________
____________
____________________
______________________________________________________________
____________
5. I affirm, under penalties of perjury, having authority to sign hereto, that the foregoing Statement is to the best of my
knowledge and belief true, correct and complete.
____________________________
____________________
__________________
________________________________
___________________
_______________________________
___________________
_______________________________
Form LLC-13.15
July 2017
Illinois
Limited Liability Company Act
Statement of Authority
Amendment or Cancellation
Printed by authority of the State of Illinois. July 2017 — 1 — LLC 50
SUBMIT IN DUPLICATE
Type or print clearly.
Filing Fee: $50
Approved:
S
ecretary of State
Department of Business Services
Limited Liability Division
501 S. Second St., Rm. 351
Springfield, IL 62756
2
17-524-8008
www.cyberdriveillinois.com
Payment may be made by check
payable to Secretary of State. If check
is returned for any reason this filing
w
ill be void.
This space for use by Secretary of State.
F
ILE #
Month, Day Year
If applicant is signing for a company or other entity, state name of company or entity.
Month, Day Year
,
Name and Title (type or print)
Signature
Street Address (Address must be street address; P.O. Box alone is unacceptable.)
City, State ZIP
