Form 814 - Application For Withdrawal Of A Foreign Limited 1997

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W. Fox McKeithen
APPLICATION FOR WITHDRAWAL OF A FOREIGN LIMITED
Secretary of State
LIABILITY COMPANY FROM THE STATE OF LOUISIANA
(R.S. 12:1351)
Foreign Limited Liability Company
Enclose $100.00 filing fee
Return to: Corporations Division
Make remittance payable to
P.O. Box 94125
Secretary of State
Baton Rouge, LA 70804-9125
Do not send cash
Phone (504)925-4704
STATE OF____________________________________________
PARISH/COUNTY OF___________________________________
_______________________________________________________________________________________________,
Limited Liability Company Name
organized under the laws of the state of ___________________________, county of ________________________
is no longer transacting business in the State of Louisiana, effective the __________________________ day of
___________________, 19 _______ , and surrenders its authority to transact business in the State of Louisiana;
revokes the authority of its registered agent to accept service of process, and consents that service of process
in any action or proceeding based on any cause of action arising out of or resulting from or connected with any
business transacted by it in this State during the time the limited liability company was authorized to transact
business in this state, be made on the limited liability company by service thereof on the Secretary of State, or
on a person in his office designated to receive service of process on limited liability companies; such service, if
made on the Secretary of State shall be mailed to:
_______________________________________________________________________________________________
Dated at __________________________________ on the ____________ day of _________________, 19________.
_____________________________________________________
Manager or Member
On this _____________ day of __________________________, 19 _____, personally came and appeared before
me __________________________________________ who being by me duly sworn, declared that he/she is a
____________________________________________________ of _______________________________________
that he/she executed the foregoing document as ______________________________________________ of the
limited liability company, and that the statements therein contained are true.
___________________________________________________________________
Notary
Date
814 Rev. 5/97
(See instructions on back)

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