STATE OF SOUTH CAROLINA SECRETARY OF STATE APPLICATION FOR REINSTATEMENT BY A LIMITED LIABILITY COMPANY DISSOLVED BY ADMINISTRATIVE ACTION TYPE OR PRINT CLEARLY IN BLACK INK Pursuant to Section 33-44-811 of the 1976 South Carolina Code of Laws, as amended, the limited liability Company dissolved by administrative action applies to the Secretary of State for reinstatement as a limited liability company and for that purpose, submits the following information: 1. 2. 3. The name of the limited liability company is____________________________________________ The effective date of administrative dissolution was______________________________________ Complete either "a" or "b" , whichever is applicable. a. [ ] b. [ ] Grounds for administrative dissolution did not exist. The grounds for administrative dissolution, which were ____________________________ _______________________________________________________________________ _________________________________________have now been eliminated. 4. 5. 6. The limited liability company's name satisfies the requirements of Section 33-44-105 of the 1976 South Carolina Code of Laws, as amended. This application is being filed within two years after the effective date of the dissolution. This form must be accompanied by a certificate from the South Carolina Department of Revenue and taxation reciting that all taxes owed by the company have been paid. Date ______________________ ______________________________________ Signature ______________________________________ Name Capacity FILING INSTRUCTIONS 1. If management of the limited liability company was vested in managers, a manager shall execute this application for reinstatement. If management of the limited liability company was reserved to the members, a member shall execute this application for reinstatement. Specify whether a member or manager is executing this application for reinstatement. File two copies of this form, the original and either a duplicate original or a conformed copy. This form must be accompanied by the filing fee of $25.00, payable to the Secretary of State. Return to: Secretary of State 1205 Pendleton Street Suite 525 Columbia, SC 29201 2. 3. Form Revised by South Carolina Secretary of State, March 2011 American LegalNet, Inc. www.FormsWorkFlow.com