Form X-4 - Application For Reinstatement
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1FORM X-4
B
R
WWW.
USINESS
7/2000
STATE OF HAWAII
DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS
Business Registration Division
1010 Richards Street
Mailing Address: P.O. Box 40, Honolulu, Hawaii 96810
APPLICATION FOR REINSTATEMENT
(Section 415-95, 415A-18, 415B-98, 425-14, 425-
, 425D-203.6, 428-811, Hawaii Revised Statutes)
PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK
The undersigned, submitting this application for reinstatement, certify as follows:
Please check one:
Profit Corporation
Nonprofit Corporation
General Partnership
Limited Partnership
LLC
LLP
(F/$50/B15)
(F/$20/B15)
(F/$25/B29, SH/12)
(F/$20/B31)
(F/$50/L14)
(F/$100/L34)
1.
Name of business entity:
_______________________________________________________________________________________________________________
(Corporation, Partnership, LLC Name)
2.
The business entity was involuntarily dissolved/canceled/revoked or administratively terminated by Decree/Order issued by
the Director of Commerce and Consumer Affairs on:
_____________________________________________________________ .
(Month
Day
Year)
3.
Attached are the delinquent annual statements/reports for the years ended December 31, ________________,
________________, ________________, ________________, ________________,
________________ .
4.
Attached is a Tax Clearance from the Department of Taxation, State of Hawaii.
5.
By this filing, all delinquent fees, penalties and other costs have been paid.
6.
Attached is payment for all filing fees, penalties and other costs in the amount of $ ____________________________ .
We certify under the penalties of Section 415-136, 415A-25, 415B-158, 425-13, 425D-204, 425D-1108, Hawaii Uniform Limited
Liability Company Act, and Hawaii Limited Liability Partnership Act, Hawaii Revised Statutes, as applicable, that we have read
the above statements and that the same are true and correct.
Signed this ____________day of ___________________________________, __________
________________________________________________________
________________________________________________________
(Type/Print Name & Title)
(Type/Print Name & Title)
________________________________________________________
________________________________________________________
(Signature)
(Signature)
SEE INSTRUCTIONS ON THE REVERSE SIDE. For corporations, application must be signed by two individuals who are officers of the
corporation. General or limited partnerships must be signed by a general partner. For LLC, must be signed and certified by at least one
manager of a manager-managed company or by at least one member of a member-managed company. LLP must be signed and certified by at
least one partner.
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