Statement Of Domestication Of Ilinois LLC {LLC-37.34(c)}

Secretary of State Department of Business Services Limited Liability Division 501 S. Second St., Rm. 351 Springfield, IL 62756 217-524-8008 www.cyberdriveillinois.com Form July 2017 LLC-37.34(c) Illinois Limited Liability Company Act Statement of Domestication of an Illinois Limited Liability Company SUBMITINDUPLICATE Type or print clearly. FILE #: This space for use by Secretary of State. Payment may be made by check payable to Secretary of State. If check is returned for any reason this filing will be void. Filing Fee: $100 Approved: 1. Limited Liability Company name: ______________________________________________________________________________ 2. The Limited Liability Company has approved a plan of domestication in accordance with this act and has domesticated to a foreign jurisdiction. The company hereby surrenders its Articles of Organization in Illinois. Form LLC 37.33 must be filed in conjunction with this form. 3. Jurisdiction after domestication: ______________________________________________________________________________ 4. A foreign Limited Liability Company may not do business in this state until an Application for Admission is on file with the Secretary of State. If the company intends to transact business in this state, the Application for Admission is attached. 5. The undersigned affirms, under penalties of perjury, having the authority to sign hereto, that this Statement of Domestication is to the best of my knowledge and belief, true, correct and complete. Dated: __________________________________________, ____________ Month, Day Year ____________________________________________________ Signature ____________________________________________________ Name and Title (type or print) ____________________________________________________ If applicant is signing for a company or other entity, state name of company or entity. Printed by authority of the State of Illinois. July 2017 -- 1 -- LLC 48.1 American LegalNet, Inc. www.FormsWorkFlow.com