Form LLC 17.21 Form Llc-45.5 - Application for Admission to Transact Business - Illinois

Form LLC17.21 is a Illinois Secretary of State form also known as the "Form Llc-45.5 - Application For Admission To Transact Business". The latest edition of the form was released in June 1, 2018 and is available for digital filing.

Download a PDF version of the Form LLC17.21 down below or find it on Illinois Secretary of State Forms website.

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LLC-45.5
Print
Reset
Illinois
FILE #
Limited Liability Company Act
Form
This space for use by Secretary of State.
May 2018
Application for Admission to
Secretary of State
Transact Business
Department of Business Services
Limited Liability Division
SUBMIT IN DUPLICATE
501 S. Second St., Rm. 351
Springfield, IL 62756
Type or print clearly.
217-524-8008
www.cyberdriveillinois.com
Payment must be made by certified check,
cashier’s check, Illinois attorney’s check,
C.P.A.’s check or money order payable to
Secretary of State. If check is returned for
any reason this filing will be void.
1. Limited Liability Company name (see Note 1): _____________________________________________________________________
2. Assumed name: ____________________________________________________________________________________________
(This item is only applicable if the company name in Item 1 is not available for use in Illinois, in which case form
LLC 1.20 must be completed and submitted with this application.)
3. Jurisdiction of organization: __________________________________________________________________________________
4. Date of organization: ________________________________________________________________________________________
5. Period of duration: __________________________________________________________________________________________
(Enter perpetual unless there is a date of dissolution provided in the agreement, in which case enter that date.)
6. Address of the principal place of business: (P.O. Box alone or c/o is unacceptable.)
_________________________________________________________________________________________________________
Number
Street
Suite #
_________________________________________________________________________________________________________
City
State
ZIP
7. Registered agent: ___________________________________________________________________________________________
First Name
Middle Name
Last Name
Registered office: ___________________________________________________________________________________________
Number
Street
Suite #
(P.O. Box alone or c/o
is unacceptable.)
IL
___________________________________________________________________________________________
City
ZIP
Note: The registered agent must reside in Illinois. If the agent is a business entity, it must be authorized to act as agent in this state.
8. If applicable, date on which company first conducted business in Illinois: _______________________________________________
(continued on back)
Printed by authority of the State of Illinois.
— 1 — LLC 17.21
June 2018
LLC-45.5
Print
Reset
Illinois
FILE #
Limited Liability Company Act
Form
This space for use by Secretary of State.
May 2018
Application for Admission to
Secretary of State
Transact Business
Department of Business Services
Limited Liability Division
SUBMIT IN DUPLICATE
501 S. Second St., Rm. 351
Springfield, IL 62756
Type or print clearly.
217-524-8008
www.cyberdriveillinois.com
Payment must be made by certified check,
cashier’s check, Illinois attorney’s check,
C.P.A.’s check or money order payable to
Secretary of State. If check is returned for
any reason this filing will be void.
1. Limited Liability Company name (see Note 1): _____________________________________________________________________
2. Assumed name: ____________________________________________________________________________________________
(This item is only applicable if the company name in Item 1 is not available for use in Illinois, in which case form
LLC 1.20 must be completed and submitted with this application.)
3. Jurisdiction of organization: __________________________________________________________________________________
4. Date of organization: ________________________________________________________________________________________
5. Period of duration: __________________________________________________________________________________________
(Enter perpetual unless there is a date of dissolution provided in the agreement, in which case enter that date.)
6. Address of the principal place of business: (P.O. Box alone or c/o is unacceptable.)
_________________________________________________________________________________________________________
Number
Street
Suite #
_________________________________________________________________________________________________________
City
State
ZIP
7. Registered agent: ___________________________________________________________________________________________
First Name
Middle Name
Last Name
Registered office: ___________________________________________________________________________________________
Number
Street
Suite #
(P.O. Box alone or c/o
is unacceptable.)
IL
___________________________________________________________________________________________
City
ZIP
Note: The registered agent must reside in Illinois. If the agent is a business entity, it must be authorized to act as agent in this state.
8. If applicable, date on which company first conducted business in Illinois: _______________________________________________
(continued on back)
Printed by authority of the State of Illinois.
— 1 — LLC 17.21
June 2018
LLC-45.5
9. Purpose(s) for which the company is organized and proposes to conduct business in Illinois (see Note 2):
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
10. The Limited Liability Company: (check one)
is managed by the manager(s) or
has management vested in the member(s):
11. List names and business addresses of all managers and any member with the authority of manager:
_________________________________________________________________________________________________________
__________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
12. The Illinois Secretary of State is hereby appointed the agent of the Limited Liability Company for service of process under
circumstances set forth in subsection (b) of Section 1-50 of the Illinois Limited Liability Company Act.
13. This application is accompanied by a Certificate of Good Standing or Existence, duly authenticated within the last 60
days, by the officer of the state or country wherein the LLC is formed.
14. The undersigned affirms, under penalties of perjury, having authority to sign hereto, that this application for admission to transact
business 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.
Note 1: The name must contain the term Limited Liability Company, LLC or L.L.C. The name cannot contain any of the following terms:
“Corporation,” “Corp.” “Incorporated,” “Inc.,” “Ltd.,” “Co.,” “Limited Partnership” or “LP.” However, a limited liability company that will provide
services licensed by the Illinois Department of Financial and Professional Regulation must instead contain the term Professional Limited
Liability Company, PLLC or P.L.L.C. in the name.
Note 2: A professional limited liability company must state the specific professional service or related professional services to be rendered
by the professional limited liability company.

Download Form LLC 17.21 Form Llc-45.5 - Application for Admission to Transact Business - Illinois

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