Ill. Admin. Code tit. 14, § 200.APPENDIX C
Section 200.ILLUSTRATION C Franchisee's Petition For Release of Escrowed Funds
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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 release from | |||||||
| escrow the sum of $ | , plus accrued interest representing the franchise 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 commenced doing business.
| Franchisee Signature | |||||
| Printed Name of Franchisee | |||||
| Address of Franchisee | |||||
| Subscribed and sworn to before me this | |||||
| day of | , | ||||
| . | |||||
| Notary Public | |||||
(Source: Amended at 23 Ill. Reg. 11561, effective September 7, 1999)