Free Cancellation/Withdrawal of a Limited Liability Company - Washington

CERTIFICATE OF CANCELLATION/WITHDRAWAL OF A LIMITED LIABILITY COMPANY
· Please PRINT or TYPE in black ink · Sign, date and return original AND ONE COPY to: CORPORATIONS DIVISION 801 CAPITOL WAY SOUTH · PO BOX 40234 OLYMPIA, WA 98504-0234 · If expedited service is used, BE SURE TO INCLUDE FEE. Checks should be made payable to "Secretary of State"
(Per Chapter 25.15 RCW)

F O R O F F I C E U S E O N L Y

NO FILING FEE
EXPEDITED (24-HOUR) SERVICE AVAILABLE ­ $20 PER ENTITY INCLUDE FEE AND WRITE "EXPEDITE" IN BOLD LETTERS ON OUTSIDE OF ENVELOPE

Important! Person to contact about this filing

Daytime Phone Number (with area code)

CERTIFICATE OF CANCELLATION/WITHDRAWAL
NAME OF LIMITED LIABILITY COMPANY (LLC) TO BE CANCELLED/WITHDRAWN

TYPE OF LLC (Check one)

Domestic (Formed in Washington State)

Foreign (Formed in any other state or jursidiction)

DATE OF CERTIFICATE OF FORMATION OR REGISTRATION

EFFECTIVE DATE OF CANCELLATION/WITHDRAWAL (Specified effective date may be up to 90 days AFTER receipt of the document by the Secretary of State)

Specific Date:
REASON FOR CANCELLATION/WITHDRAWAL

Upon filing by the Secretary of State

ADDRESS WHERE SERVICE OF PROCESS MAY BE FORWARDED (Foreign LLCs ONLY) Street Address or PO Box City State ZIP or Postal Code

>>> PLEASE ATTACH ANY OTHER INFORMATION THE LLC ELECTS TO INCLUDE <<<
SIGNATURE OF MEMBER/MANAGER

I certify under penalty of perjury under the laws of the State of Washington that I am authorized to sign on behalf of the Limited Liability Company (LLC) submitting this cancellation/withdrawal and that the foregoing is, to the best of my knowledge, true and correct.
F O R

Signature

Printed Name

O F F I C E U S E O N L Y 025-009 (9/00)

Title

Date

PUBLIC DISCLOSURE NOTICE All information provided to the Office of the Secretary of State is available for public inspection

INFORMATION AND ASSISTANCE ­ 360/753-7115 (TDD ­ 360/753-1485)