INSTRUCTIONS: 1. Use 8 275224 x 11224 white paper for attachments. 2. Please TYPE or PRINT in INK. 3. Please visit our office on the web at www.sos.IN.gov 4. Make check or money order payable to the Secretary of State. 5. Submit original completed paperwork and payment to: 302 West Washington Street, Room E-018, Indianapolis, IN 46204. 6. The Application for Reinstatement must include the following: Certificate of Clearance issued by the Indiana Department of Revenue Business Entities Reports for all outstanding years due NOTE: This application for reinstatement cannot be accepted without a Certificate of Clearance for reinstatement from the Indiana Department of Revenue. NOTE: This application must be submitted within five (5) years of the effective date of the administrative dissolution. (SOS use only) (If different from above 226 SOS use only) American LegalNet, Inc. www.FormsWorkFlow.com (month, day, year) (month, day, year) American LegalNet, Inc. www.FormsWorkFlow.com