1. Limited Liability Company name as of the date of issuance of Notice of Dissolution or Revocation:
______________________________________________________________________________________________
2. If applicable, new name of Limited Liability Company (Form LLC 5.25 or LLC 45.25 must accompany this application):
______________________________________________________________________________________________
3. State of organization: ____________________________________________________________________________
4. Date Notice of Dissolution or Revocation issued: __________________________________________________________
5. Registered agent: ______________________________________________________________________________
First Name Middle Initial Last Name
Registered office: ______________________________________________________________________________
(P.O. Box and
Number Street Suite #
c/o are unacceptable) ______________________________________________________________________________
City ZIP Code
Note: If the registered agent and/or office address has changed since dissolution or revocation, complete form LLC 1.36/1.37
and submit with this application.
This application is accompanied by all amendments necessary to change, add or remove an existing provision, by all delinquent
reports, information requirements and registrations due and therefore becoming due, together with all fees and penalties required.
I affirm under penalties of perjury, having authority to sign hereto, that this application for reinstatement is to the best of my
knowledge and belief, true, correct and complete.
Dated: ___________________________, ______________
Month/Day Year
________________________________________________
Signature
________________________________________________
Name and Title (type or print)
________________________________________________
If applicant is signing for a company or other entity,
state name of company or entity.
Form LLC-35.40/
45.65
July 2017
Illinois
Limited Liability Company Act
Application for Reinstatement Following
Administrative Dissolution or Revocation
Total payment must be made by
c
ertified check, cashier’s check,
Illinois attorney’s check, Illinois
C.P.A.’s check or money order
payable to Secretary of State.
Printed by authority of the State of Illinois. December 2017 — 1 — LLC 8.11
IL
T
his space for use by Secretary of State.
F
iling Fee: $200
Approved:
FILE #
Secretary of State
Department of Business Services
Limited Liability Division
501 S. Second St., Rm. 351
S
pringfield, IL 62756
217-524-8008
www.cyberdriveillinois.com
SUBMIT IN DUPLICATE
T
ype or print clearly.
(P.O. Box alone or
c/o is unacceptable.)
