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Illinois FILE #
FormLLC-5.40
May 2012 Limited Liability Company ActThis space for use by Secretary of State.
Secretary of State Application for Withdrawal –
Department of Business ServicesDomestic
Limited Liability Division
501 S. Second St., Rm. 351SUBMIT IN DUPLICATE
Springfield, IL 62756 Type or Print Clearly.
217-524-8008
www.cyberdriveillinois.comThis space for use by Secretary of State.
Payment may be made by check
payable to Secretary of State. IfFiling Fee: $5
check is returned for any reason this
filing will be void. Approved:
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 frombecoming
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.
Printed by authority of the State of Illinois. December 2017 — 1 — LLC 12.6
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