Llc Application For Certificate Of Reinstatement - Wyoming Secretary Of State, Statement Of Change Of Registered Agent And/or Registered Office By Business Entity - Wyoming Secretary Of State Etc.

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Wyoming Secretary of State
State Capitol Building, Room 110
th
200 West 24
Street
For Office Use Only
Cheyenne, WY 82002-0020
Ph. 307.777.7311
Fax 307.777.5339
Email: business@state.wy.us
Limited Liability Company
Application for Certificate of Reinstatement
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. Limited liability company name:
2. Effective date of its administrative dissolution:
(Date – mm/dd/yyyy)
3. Grounds for dissolution have been eliminated.
Signature: ___________________________________________
Date:
(Shall be executed by a member, manager, or other authorized individual as
(mm/dd/yyyy)
set forth in the operating agreement.)
Print Name:
Title:
Contact Person:
Daytime Phone Number:
Email:
Checklist
Check one box only:
(a) Failure to file annual report - 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.
(b) Failure to maintain registered agent - 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 of $50.00 together with a penalty of $250.00 for a total fee of $300.00
plus any delinquent annual reports and taxes due.
Make check or money order payable to Wyoming Secretary of State.
Please submit one originally signed document and one exact photocopy of the filing.
Please review form prior to submitting to the Secretary of State to ensure all areas have been
completed to avoid a delay in the processing of your documents.
LLC-CertificateReinstatement –3/23/2009

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