Illinois > Secretary Of State > Limited Liability Company
Petition For Refund LLC-5.48 - Illinois
| Petition For Refund Form. This is a Illinois form and can be used in Limited Liability Company Secretary Of State . |
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Form May 2012 Secretary of State Department of Business Services Limited Liability Division 501 S. Second St., Rm. 351 Springfield, IL 62756 217-524-8008 www.cyberdriveillinois.com Payment may be made by check payable to Secretary of State. If check is returned for any reason this filing will be void. LLC-5.48 Illinois Limited Liability Company Act FILE # This space for use by Secretary of State. Petition for Refund SUBMITINDUPLICATE Type or print clearly. This space for use by Secretary of State. Filing Fee: $15 Approved: 1. Limited Liability Company Name: ___________________________________________________________________ 2. State of Organization: ____________________________________________________________________________ 3. Amount of Claim: ________________________________________________________________________________ No refund shall be made from an overpayment of less than $200. Any amount to be refunded shall be reduced by $200. 4. Details of Transaction and all facts upon which the petitioner relies: (If there is not sufficient space to cover this point, attach additional sheets of this size.) 5. I affirm, under the penalties of perjury, having the authority to sign hereto, that this penalty form is to the best of my knowledge and belief, true, correct and complete. Date: _________________________, ___________ Month/Day Year ________________________________________ Signature ________________________________________ Name and Title (type or print) ________________________________________ If applicant is a Company or other Entity, state Name of Company and indicate whether it is a member or manager of the LLC. Printed by authority of the State of Illinois. May 2012 -- 1 -- LLC 35.4 American LegalNet, Inc. www.FormsWorkFlow.com
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