Ill. Admin. Code tit. 14 , J, Appendix F, ILLUSTRATION A
__________ | ) | |
__________ | ) | SS |
__________ | ) |
IN THE MATTER OF:
FRANCHISOR:
FRANCHISEE:
BEFORE THE ATTORNEY GENERAL OF ILLINOIS
AS ADMINISTRATOR FOR THE FRANCHISE DISCLOSURE ACT
The undersigned franchisor hereby requests the Administrator to authorize release of the Certificate of Deposit in the name of the Administrator in the sum of $16950, plus accrued interest representing the franchise fee paid by _________on the _______ day of______, ______.
The undersigned franchisor hereby represents that it has fulfilled the initial obligations owed to the franchisee under the franchise and other agreements and that the franchisee has commenced doing business.
In furtherance of this request, the undersigned franchisor submits the franchisee's statement indicating the franchisee has no objection to this request. By this statement the franchisee has not waived any rights which he may have against the undersigned franchisor.
________________________ | ||
Franchisor | ||
By: ____________________ | ||
Name and Title | ||
Subscribe and sworn to before me | ________________________ | |
this _________day of ________,___ | Printed Name of Franchisee | |
_____________________________ | _______________________ | |
Notary Public | Address of Franchisee | |
Ill. Admin. Code tit. 14 , J, Appendix F, ILLUSTRATION A