Free - West Virginia

Natalie E. Tennant Secretary of State State Capitol Bldg. 1900 Kanawha Blvd. East Charleston, WV 25305
www.wvsos.com

Penney Barker, Manager Corporations Division Tel: (304) 558-8000 Fax: (304) 558-8381 Hrs - 8:30-5:00pm
[email protected] WEST VIRGINIA STATEMENT OF DISSOCIATION FOR A LIMITED LIABILITY COMPANY

FEE: $15

In accordance with §31B-7-704 of the Code of West Virginia, the undersigned organization adopts the following Articles of Dissociation:

The name of the organization is:

Date of filing Articles of Organization or Certificate of Authority with the West Virginia Secretary of State:

The name and address of the person(s) being dissociated from the company: Name Address City, State, Zip

Contact name and number of person to reach in case of problem with filing: (optional, however, listing one may help to avoid a return or rejection of filing if there appears to be a problem with the document) Name: Phone:
Business email address, if any:

Signature of person executing document:

Signature

Capacity in which he/she is signing (Example: member, manager, etc.)

PRINT THIS COPY, THEN CLICK HERE TO RESET.

Form LLD-F-2

Issued by the WV Secretary of State

Revised 1/09