1. Limited Liability Company Name:____________________________________________________________________
______________________________________________________________________________________________
2. The company has submitted prospective Articles of Organization filed on _______________________________________
Date
with a pending effective date of ______________________________. In accordance with Section 5-40(b) of the Illinois
Limited Liability Company Act, the Organizer hereby withdraws the Articles of Organization to prevent the filing from becoming
effective.
3. 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 of Organizer
________________________________________________
Name (type or print)
________________________________________________
If organizer is a Company or other Entity,
state Name of Company and Title of Signer.
Form LLC-5.40
May 2012
Illinois
Limited Liability Company Act
Application for Withdrawal –
Domestic
Printed by authority of the State of Illinois. December 2017 — 1 — LLC 12.6
SUBMIT IN DUPLICATE
Type or Print Clearly.
This space for use by Secretary of State.
Filing Fee: $5
Approved:
Secretary of State
Department of Business Services
Limited Liability Division
501 S. Second St., Rm. 351
Springfield, IL 62756
217-524-8008
www.cyberdriveillinois.com
Payment may be made by check
payable to Secretary of State. If
check is returned for any reason this
filing will be void.
This space for use by Secretary of State.
FILE #
