Legal Application for Reinstatement

LEGAL APPLICATION FOR REINSTATEMENT

This Application for Reinstatement is submitted by Applicant Name: to Reinstating Authority: . The Applicant requests that the Reinstating Authority reinstate the Applicant's status, rights, privileges and corporate or organizational powers previously forfeited, administratively terminated, or revoked.

Jurisdiction of Formation: | Entity Type: Corporation LLC Partnership Individual Other

File Number or Identifier: | Date of Administrative Termination/Revocation:

RECITALS

WHEREAS, Applicant Name: was originally formed under the laws of Jurisdiction of Formation: and was assigned File Number: .

WHEREAS, the Applicant's good standing, active status or charter was forfeited, administratively terminated, or revoked on Date of Administrative Termination/Revocation: for reasons including but not limited to failure to file required reports, failure to maintain a registered agent, or nonpayment of fees.

WHEREAS, the Applicant seeks reinstatement and represents that the conditions required for reinstatement under the governing statutes have been satisfied or will be satisfied upon acceptance of this Application and payment of applicable fees.

NOW, THEREFORE

The Applicant submits this Application and states the following under penalty of perjury and pursuant to the authority of the Reinstating Authority.

1. APPLICATION FOR REINSTATEMENT

1.1 Applicant hereby applies for reinstatement to active status and requests that all rights, privileges, powers, and liabilities of the Applicant be restored to the extent permitted by law. The Applicant agrees to comply with all statutory conditions for reinstatement and to submit any additional documents or payments required by the Reinstating Authority.

2. GROUNDS AND BASIS FOR REINSTATEMENT

2.1 Stated grounds for termination or revocation (check all that apply): Non-filing of reports Nonpayment of fees Failure to maintain registered agent Other (describe below)

3. ATTACHMENTS AND DOCUMENTATION

3.1 The Applicant submits the following documents with this Application (check each submitted): Cover letter Affidavit of applicant or officer Certificate of good standing or equivalent Outstanding reports or annual statements

4. FEES, PENALTIES AND PAYMENT

4.1 Payment method: Check Credit/Debit Card Electronic Transfer Other

5. REPRESENTATIONS, CERTIFICATIONS AND AUTHORIZATION

5.1 The Applicant certifies that all statements contained in this Application and in any accompanying documents are true, correct and complete to the best of the signatory's knowledge and belief. The signatory further certifies that the signatory is authorized to submit this Application on behalf of the Applicant and to accept the legal consequences of reinstatement.

5.2 Applicant acknowledges that reinstatement may be conditioned upon payment of all outstanding taxes, fees, penalties, assessments, filing of delinquent reports, and compliance with any statutory or regulatory requirements. Applicant agrees to hold harmless the Reinstating Authority for any delay or denial resulting from incomplete submission or failure to meet statutory conditions.

6. NOTICES

7. MISCELLANEOUS PROVISIONS

Governing Law: This Application and any reinstatement granted pursuant to it shall be governed by and construed in accordance with the laws of Governing Law State: , without regard to conflict of laws principles.

Entire Agreement: This Application, together with any documents incorporated by reference or submitted herewith, constitutes the entire agreement between the Applicant and the Reinstating Authority with respect to the subject matter hereof and supersedes all prior communications and proposals.

Severability: If any provision of this Application is determined to be invalid or unenforceable, such invalidity or unenforceability shall not affect the remaining provisions, which shall continue in full force and effect.

Amendments and Waiver: No amendment or waiver of any provision of this Application shall be effective unless in writing and signed by an authorized representative of the Applicant and, where applicable, accepted by the Reinstating Authority. No failure or delay in exercising any right shall operate as a waiver.

8. DECLARATION

The undersigned declares under penalty of perjury under the laws of the governing jurisdiction that the information contained in this Application and in any attachments is true, accurate and complete.

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