State of Utah DEPARTMENT OF COMMERCE Division of Corporations & Commercial Code Application for Reinstatement File Number: Non-Refundable Processing Fee: [ ] Profit $52.00 [ ] Nonprofit $22.00 [ ] Limited Partnership $52.00 [ ] Limited Liability Company $52.00 Business Entity Name: *Please enter the business name under which the entity is being reinstated on the line above, however, if the entity is reinstating under a different name, please list that name on the line below: ____________________________________________________________________________________________ (New Business Entity Name) I, _________________________________________________________________, hereby declare and affirm that (Print Name) I am a(n) ____________________________________ of _____________________________________________, (Officer, General Partner, or Member) which was involuntarily dissolved on ( Business Name ) , 20 , under provisions of Utah law. I hereby remedy all prior defaults and file herewith a current Registration Information Change Form listing the current entity principals together with the statutory reinstatement fee. I hereby make application for reinstatement and request the Division of Corporations and Commercial Code of the State of Utah to issue a Certificate of Reinstatement and, under penalties of perjury, I declare that the foregoing statement is, to the best of my knowledge and belief, true and correct. By: Signature: Registered Agent Name, Address and Signature (Required): Title: I, ________________________________________, hereby declare and affirm that I am the Registered Agent of (Print Name) __________________________________________________________, and my address for service of process is: ( Business Name ) _____________________________________________________________ Utah ___________ Street Address City Zip (Utah Street Address Required, PO Boxes can be listed after the street address) Registered Agent Signature: Submit with this application a completed Registration Information Change Form reflecting the current principal information. Enclose a tax letter of Good Standing from the Utah Tax Commission (applicable to Profit and Nonprofit Corporations). Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity. American LegalNet, Inc. www.FormsWorkflow.com