District of Columbia Government Corporations Division Application for Certificate of Reinstatement for Domestic Limited Liability Company Form DLC-4 Version 2, July 2010. Use this form to reinstate a domestic limited liability company (LLC) in the District of Columbia. ENTITY TYPE Domestic Limited Liability Company FILING FEE Refer to Corporate Fee Schedule posted online; Pursuant to the provisions of Title 29, Chapter 10 of the Code of Laws of the District of Columbia, the undersigned limited liability company hereby petitions and applies for a Certificate of Reinstatement of a proclaimed domestic limited liability company and hereby certifies as follows: 1. Entity Name at the time of proclamation: 2. New name that the company will be known as from now on. (If the LLC name is available, you must use that name; if the name has been taken by another company, then you may choose a different name.) 3. The Certificate of Organization to transact business in the District of Columbia was revoked on the following date for failure and/or refusal to file reports for the reporting period or other reasons under DC Official Code (DCOC). (Revocation dates are always the 2nd Monday of November of the revocation year) 4a. Registered Agent in the District of Columbia at the time of proclamation: 4b. That Registered Agent's address: 5. Attach any DCOC-required delinquent reports and filing fees and penalties. 7. Signature: 6. Indicate Company Representative executing this form: Manager Member Authorized Person If you sign this application, you agree that you understand that anyone who makes a false statement anywhere on it can be punished by criminal penalties of a fine up to $1000, imprisonment up to 180 days, or both, under DCOC § 22-2405. Mail all forms and required payment to: Department of Consumer and Regulatory Affairs Corporations Division PO Box 92300 Washington, DC 20090 Phone: (202) 442-4400 Please check dcra.dc.gov to view organizations required to register, to search business names, to get step-by-step guidelines to register an organization, to search registered organizations, and to download forms and documents. Just click on "Corporate Registrations." American LegalNet, Inc. www.FormsWorkFlow.com