LIMITED LIABILITY COMPANY APPLICATION FOR CERTIFICATE OF REINSTATEMENT FOLLOWING ADMINISTRATIVE DISSOLUTION Wyoming Secretary of State The Capitol Building, Room 110 200 W. 24th Street Cheyenne, WY 82002-0020 Phone (307) 777-7311/7312 Fax (307) 777-5339 E-mail: corporations@state.wy.us A limited liability company administratively dissolved under W.S. 17-15-112 may apply to the Secretary of State for reinstatement within two (2) years after the effective date of dissolution. 1. The name of the limited liability company is: ______________________________________________________________________________ 2. The effective date of its administrative dissolution was: _________________________________ 3. The grounds for dissolution have been eliminated. Date:_________________________ Signed:_________________________________________ Title: ___________________________________________ *********************************************************************************** Reinstatement fee: $50.00 Instructions: 1. If the limited liability company was administratively dissolved for failure to file its annual report and pay the annual license tax, all delinquent reports must accompany this form along with the $50.00 reinstatement fee and double taxes for each delinquent report. 2. If the limited liability company was administratively dissolved for failure to maintain a registered agent and/or registered office in this state, a completed statement of change of registered agent/office and registered agent consent must accompany this form along with the reinstatement fee ($50.00), and penalty ($100.00) for a total fee of $150.00 plus any delinquent annual reports and taxes due. 2/2007 American LegalNet, Inc. www.FormsWorkflow.com