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Application For Reinstatement X-4 - Hawaii
|Application For Reinstatement Form. This is a Hawaii form and can be used in General Business Business Registration Secretary Of State .||
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WWW.BUSINESSREGISTRATIONS.COM FO RM X-4 7/2002 Nonrefundable Filing Fee: Profit Corporation: $50.00 STATE OF HAWAII Nonprofit Corporation: $20.00 General Partnership: $25.00 DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS Limited Partnership: $20.00 Business Registration Division *X4* LLC: $50.00 1010 Richards Street LLP: $50.00 Mailing Address: P.O. Box 40, Honolulu, Hawaii 96810 APPLICATION FOR REINSTATEMENT (Section 414-403, 415A-18, 414D-250, 425-14, 425-164, 425D-203.6, 428-811, Hawaii Revised Statutes) PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK The undersigned, submitting this application for reinstatement, certify as follows: 1. The entity is (check one): Profit Corporation Nonprofit Corporation General Partnership Limited Partnership LLC LLP (F/$50/B15) (F/$20/B15) (F/$25/B29, SH/12) (F/$20/B31) (F/$50/L14) ( F/$50/L34) 2. Name of business entity: ______________________________________________________________________________________________________________ (Corporation, Partnership, LLC Name) 3. The business entity was involuntarily dissolved/canceled/revok ed or administratively terminated by Decree/Order issued by the Director of Commerce and Consumer Affairs on: _____________________________________________________________ . ( Month Day Year ) 4 Attached are the delinquent annual statements/reports for the years ended December 31, ________________, ________________, ________________, ________________, ________________, ________________ . 5. Attached is a Tax Clearance from the Department of Taxation, State of Hawaii. 6. By this filing, all delinquent fees, penalties and other costs have been paid. 7. Attached is payment for all filing fees, penalties and other costs in the amount of $ ____________________________ . We certify under the penalties of Section 414-20, 414D- 12, 425-13, 425D-204, 425D-1108, 428-1302, and 425-172, Hawaii Revised Statutes, as applicable, that we have read the above statements and that the same are true and correct. Signed this ____________day of ___________________________________, __________ _______________________________________________________ ________________________________________________________ (Type/Print Name & Title) (Type/Print Name & Title) _______________________________________________________ ________________________________________________________ (Signature) (Signature) SEE INSTRUCTIONS ON REVERSE SIDE <<<<<<<<<********>>>>>>>>>>>>> 2 FO RM X-4 7/2002 Instructions : Application must be typewritten or printed in black ink , and must be legible . All signatures must be in black ink. Submit original application together with the appropriate fee(s). The reinstatement period is within two years after the involuntary dissolution/cancellation/revocation or administrative termination of the entity. Only domestic entities may apply for reinstatement. Execution: For profit and nonprofit corporations , document must be signed by at leas t one officer of the corporation. For general partnerships must be signed by at least one general partner. For limited partnerships must be signed by at least one general partner. For LLC , must be signed and certified by at least one manager of a manager-managed company or by at least one member of a member-managed company. For LLP , must be signed and certified by at least one partner. Line 1. Check the appropriate box. Line 2. State the full name of the business entity. Line 3. State the date of involuntary dissolution/cancellation/revocation/termination. Line 4. State the year s that annual statements/reports were delinquent. Filing Fees : Filing fees are not refundable . Make checks payable to DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS. Profit Corporation ($50) Nonprofit Corporation ($20) General Partnership ($25) Limited Partnership ($20) LLC ($50) LLP ($50) Dishonored Check ($15 fee plus interest charge) NOTICE: THIS MATERIAL CAN BE MADE AVAILABLE FOR INDIVIDUALS WITH SPECIAL NEEDS. PLEASE CALL THE DIVISION SECRETARY, BUSINESS REGISTRATION DIVISION , DCCA, AT 586-2744, TO SUBMIT YOUR REQUEST.