Form 08-476 - Application For Certificate Of Cancellation - Alaska Department Of Community And Economic Development

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Date: _____________________
Amt: _____________________
Ck.#: _____________________
Name: _____________________
___________________________
Corporation email/website address: ___________________________
STATE OF ALASKA
APPLICATION FOR CERTIFICATE OF CANCELLATION
Pursuant to the provisions of Section 10.50.660 of the Alaska Revised Limited Liability Act, the undersigned company applies for
a Certificate of Cancellation from the State of Alaska.
1.
The name of the company is:
2.
It is organized under the laws of:
3.
It hereby surrenders its authority to transact business in the State of Alaska.
4.
It hereby revokes the authority of its registered agent in Alaska and consents that service of process may subsequently be
made on the company by service on the Commissioner of Community and Economic Development.
5.
The mailing address to which the Commissioner of Community and Economic Development may mail a copy of any
process against the company that may be served on him is:
Date
,
Signed:
Signature of person executing document
Title:
Note whether member, manager, or attorney-in-fact
MAIL THE ORIGINAL AND AN EXACT COPY OF THE APPLICATION
ALONG WITH THE $25.00 FILING FEE TO:
Department of Community and Economic Development
Corporations Section
P.O. Box 110808
Juneau, Alaska 99811-0808
(907) 465-2530
08-476 (7/99)

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