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                                         District of Columbia Government 
                                                Corporations Division 

                                      Reinstatement of Domestic Filing Entity. 
                                             Form GN-5, Ver. 3, October 2022 

Use this form to reinstate domestic filing entity that was administratively dissolved. 

                      ENTITY TYPE / AUTHORITY                                                     FILING FEE 
               Domestic Filing Entity:   § 29–106.03.                Refer to Corporate Fee Schedule           posted online; 

Under the provisions of the Title 29 of D.C. Code (Business Organizations Act), the domestic filing entity listed below 
hereby applies for a Certificate of Reinstatement and for that purpose submits the statement below. 
1. Entity Name

2. Entity’s Alternate Name (this field should only be used if entity’s true name is not available)

3. Date of Administrative Dissolution                           4. Date of Filing

5. The following grounds for termination have been cured.

5A. Biennial report has been filed. 

5B. Registered agent has been appointed. 

5C. All fees and penalties required by Title 29 have been paid. 

               If you sign this form you agree that anyone who makes a false statement can be punished by criminal penalties 
                            of a fine up to $1000, imprisonment up to 180 days, or both, under DCOC § 22-2405; 
6. Name of the Governor or Authorized Person                         6A. Signature of the Governor or Authorized Person 

Mail all forms and required payment to:                         Many corporate filings are available online. 
Department of Licensing and Consumer Protection 
Corporations Division                                           Go to our CorpOnline site at https://corponline.dlcp.dc.gov  and sign 
PO Box 92300                                                    in with Access DC to proceed. 
Washington, DC 20090 
Phone: (202) 442-4432                                           Online filings are paid by credit card.