1. Limited Liability Company name: ____________________________________________________________________
Registered agent:________________________________________________________________________________
Registered office: _____________________________________________________________IL_________________
2. State or country of organization: ________________________ Date organized in or admitted to Illinois: _____________
3.
Address of principal place of business: (P.O. Box alone is unacceptable.)
_______________________________________________________________________________________________
4. Names and business addresses of managers and any member with the authority of manager:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
5. Managers other than a natural person affirm their current existence.
6. Changes to the registered agent and/or registered office must be submitted on Form LLC-1.36/1.37.
7. I affirm, under penalties of perjury, having authority to sign thereto, that this Annual Report 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 a company or other entity, state name of company or entity.
Form LLC-50.1
August 2018
Illinois
Limited Liability Company Act
Annual Report
Printed by authority of the State of Illinois. August 2018 — 1 — LLC 23.14
Type or print clearly.
Filing Fee: $75
Series Fee, if required:
Penalty:
Total:
A
pproved:
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.
T
his space for use by Secretary of State.
F
ILE #
D
ue prior to:
N
umber Street Suite City ZIP
Number Street Suite City, State ZIP
A late filing penalty of $100 will apply
if this report is not filed within 60 days
after the due date.
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