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                                                                                                                                                                                 F ILE #
Form                                                                                                         Illinois 
August 2018LLC-50.1                                                              Limited Liability Company Act                                                                   D ue prior to:

S ecretary of State                                                                                         Annual Report                                                        T his space for use by Secretary of State.
Department of Business Services
Limited Liability Division                                                                  Type or print clearly.
501 S. Second St., Rm. 351
Springfield, IL  62756                 Filing Fee:   $75
2 17-524-8008
www.cyberdriveillinois.com             Series Fee, if required:
                                       Penalty:
Payment may be made by check           Total:
payable to Secretary of State. If check
                                       A pproved:
is returned for any reason this filing
w ill be void.

1. Limited Liability Company name:____________________________________________________________________

   Registered agent:________________________________________________________________________________

   Registered office: _____________________________________________________________IL_________________N umber Street Suite                           City                                                                            ZIP

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.) 

   _______________________________________________________________________________________________Number Street                               Suite                                       City, State                     ZIP

4. Names and business addresses of managers and any member with the authority of manager: 
   ______________________________________________________________________________________________
   N a m e                                                                        N u m b e r  &  S tr e e t                                 C ity , S ta te                                                        Z IP
   ______________________________________________________________________________________________
   N a m e                                                                        N u m b e r  &  S tr e e t                                 C ity , S ta te                                                        Z IP
   ______________________________________________________________________________________________
   N a m e                                                                        N u m b e r  &  S tr e e t                                 C ity , S ta te                                                        Z IP
   ______________________________________________________________________________________________
   N a m e                                                                        N u m b e r  &  S tr e e t                                 C ity , S ta te                                                        Z IP
   ______________________________________________________________________________________________
   N a m e                                                                        N u m b e r  &  S tr e e t                                 C ity , S ta te                                                        Z IP

   ______________________________________________________________________________________________N a m e                                                                        N u m b e r  &  S tr e e t C ity , S ta te                                                        Z IP

   ______________________________________________________________________________________________C ity , S ta te                                                        Z IP
   N a m e                                                                        N u m b e r  &  S tr e e t
                                                                               ( A d d  a d d itio n a l s h e e ts  o f th is  s iz e  if m o r e  s p a c e  is  n e e d e d .)

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: ___________________________, ______________
   A late filing penalty of $100 will apply                                                                                                          Month/Day                                         Year
   if this report is not filed within 60 days
   after the due date.                                                                                       ________________________________________________
                                                                                                                                                                                 Signature 
                                                                                                             ________________________________________________
                                                                                                                                                     Name and Title (type or print)
                                                                                                             ________________________________________________
                                                                                                             If applicant is a company or other entity, state name of company or entity.
                               Printed by authority of the State of Illinois. August 2018 — 1 — LLC 23.14