Certificate Of Cancellation (Foreign/non Washington) - Washington Secretary Of State
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Limited Liability Company
See attached detailed instructions
□
No Fee for Standard Service
□
Expedited Service $50.00
UBI Number:
CERTIFICATE OF CANCELLATION (Foreign/Non Washington)
Chapter 25.15 RCW
SECTION 1
NAME OF LIMITED LIABILITY COMPANY: (as currently recorded with the Office of the Secretary of State)
MAILING ADDRESS TO RETURN THE COMPLETED DOCUMENT:
_______________________________________________________________
City
State
Zip Code
SECTION 2
ORIGINAL DATE FOR CERTIFICATE OF REGISTRATION:
SECTION 3
EFFECTIVE DATE OF CANCELLATION: (please check one of the following)
□
Upon filing by the Secretary of State
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Specific Date: __________________ (Specified effective date must be within 90 days AFTER the Cancellation
has been filed by the Office of the Secretary of State)
SECTION 4
ADDRESS WHERE SERVICE OF PROCESS MAY BE FORWARDED: (REQUIRED)
Address: _______________________________
City___________________State
_Zip Code_______
SECTION 5
REASON FOR CANCELLATION: (if necessary, attach additional information)
SECTION 6
MEMBER OR MANAGER SIGNATURE (see instructions page)
This document is hereby executed under penalties of perjury, and is, to the best of my knowledge, true and correct.
X_______________________________________________________________________________________
Signature
Printed Name/Title
Date
Phone
FOREIGN LLC - Cancellation
Washington Secretary of State
Revised 03/13
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