Ill. Admin. Code tit. 14 , J, Appendix F, ILLUSTRATION B
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IN THE MATTER OF:
FRANCHISOR:
FRANCHISEE:
BEFORE THE ATTORNEY GENERAL OF ILLINOIS
AS ADMINISTRATOR FOR THE FRANCHISE DISCLOSURE ACT
The undersigned franchisee hereby requests the Administrator to authorize the release of the Certificate of Deposit issued in the name of the Administrator in the sum of ___________, plus accrued interest representing the franchisee fee paid by me on the ___________ day of _________, ____.
The undersigned franchisee hereby represents that the franchisor has not fulfilled the initial obligations owed to me under the franchise and other agreements and that I have not has commenced doing business.
In furtherance of this request, the undersigned franchisor submits the franchisee's statement indicating that it has no objection to this request.
_______________________________ Signature |
_______________________________ |
Printed Name of Franchise |
________________________________ |
Address of Franchisee |
Subscribe and sworn to before me this _______________ day of _____,___. |
_________________________________ |
_________________________________ |
Notary Public |
Ill. Admin. Code tit. 14 , J, Appendix F, ILLUSTRATION B