This form must be type written or computer generated.                Link to Registration Information Change Form

                                                                                                                      Link to Guide Sheet

                                                                                                                      Print Form          Clear Form
                                            Link to Tax Commission Forms

         State of Utah 
         Department of Commerce 
         Division of Corporations & Commercial Code 
         Application for Reinstatement 

                                                                                    Link to Registration Information Change Form
                                                                                                                      Link to Guide Sheet
                                            This form cannot be hand written.                                                             Clear Form

Non-Refundable Processing Fee: [    ] Limited Partnership $54.00 [    ]  Limited Liability Company $54.00  
[    ]  Uniform LCA $22.00         Limited Liability Partnership $54.00 
Entity Number of Business Entity: 
Business Entity Name: 
*Please enter the business name under which the entity is being reinstated on the line above, however, if the entity is reinstating
under a different name, please list that name on the line below:
____________________________________________________________________________________________ 
                                            (New Business Entity Name) 
Submit with this application a completed Registration Information Change Form reflecting the current
 principal information (only needed if principals have changed). 

Registered Agent Name and Address (Required):                                                            What is a commercial registered agent?
Who/What is the Registered Agent (Individual or Business Entity or Commercial Registered Agent)?: 
________________________________________________________________________________________ 
The  address must be listed if you have a non-commercial registered agent.  See instructions for further details.  
Address of the Registered Agent: ___________________________________________________________ 
                                   Utah Street Address Required, PO Boxes can be listed after the Street Address 
City:           State  UT         Zip: 
I hereby remedy all prior defaults and file herewith a current Registration Information Change Form listing the current entity 
principals together with the statutory reinstatement fee. 
I hereby make application for reinstatement and request the Division of Corporations and Commercial Code of the State of Utah 
to issue a Certificate of Reinstatement and, under penalties of perjury, I declare that the foregoing statement is, to the best of my 
knowledge and belief, true and correct. 
I, _________________________________________________________________, hereby declare and affirm that 
                                                                    (Name) 
I am a(n) ____________________________________ (Officer/Chairperson, General Partner, or Member/Manager)              of the business entity 
listed above, which was involuntarily dissolved on   _________________________ , 20 _______ , under 
provisions of Utah law. 
Signature (Required):  
Under GRAMA {63G-2-201}, all registration information maintained by the Division is classified as public record.  For confidentiality purposes, you 
may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity. 
Optional Inclusion of Ownership Information:  This information is not required. 
Is this a female owned business?          Yes                    No 
Is this a minority owned business?        Yes                    No       If yes, please specify: Select/Type the race of the owner here

07/23