1. Limited Liability Company name: ____________________________________________________________________
2. Post Office address to which a copy of any process against the Limited Liability Company that may be served on the
Secretary of State may be mailed:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
3. The Limited Liability Company has been terminated.
4. The undersigned affirms, under penalties of perjury, having authority to sign hereto, that this Statement of Termination is to
the best of my knowledge and belief, true, correct and complete.
Dated _________________________________, _______________
Month & Day Year
______________________________________________________________
Signature
______________________________________________________________
Name and Title (type or print)
______________________________________________________________
Form LLC-35.15
July 2017
Illinois
Limited Liability Company Act
Statement of Termination
Printed by authority of the State of Illinois. December 2017 — 1 — LLC 9.8
RETURN TO: (Please type or print clearly.)
_____________________________________________
Name
_____________________________________________
Street
_____________________________________________
City, State, ZIP Code
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
SUBMIT IN DUPLICATE
Type or print clearly.
Filing Fee: $5
Approved:
This space for use by Secretary of State.
F
ILE #
If applicant is signing for a company or other entity,
state name of company or entity.
Payment may be made by check
payable to Secretary of State. If check
is returned for any reason this filing
w
ill be void.
