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FILE #
Form Illinois
LLC-5.47 Limited Liability Company Act This space for use by Secretary of State.
July 2017
Secretary of State Statement of Correction
Department of Business Services
Limited Liability Division
501 S. Second St., Rm. 351 SUBMIT IN DUPLICATE
Springfield, IL 62756 Type or print clearly.
217-524-8008
www.ilsos.gov
Payment may be made by check
Filing Fee: $25
payable to Secretary of State. If
check is returned for any reason this Approved:
filing will be void.
1. Limited Liability Company name: __________________________________________________________________
2. State or country of organization: ____________________________________________________________________
3. Title of document to be corrected: _____________________________________________________________________
4. Date erroneous document filed by Secretary of State: ______________________________________________________
5. Inaccuracy, error or defect: __________________________________________________________________________
(Briefly identify the error and explain how it occurred. If more space is needed, use reverse side or attach additional sheets of this size.)
6. Corrected portion(s) of document in corrected form: ________________________________________________________
(If more space is needed, use reverse side or attach additional sheets of this size.)
7. I affirm, under the penalties of perjury, having the authority to sign hereto, that this Statement of Correction 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.
Printed by authority of the State of Illinois. January 2018 — 1 — LLC 34.4
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