Form Llc-4/8 - Limited Liability Company Short Form Certificate Of Cancellation
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1LLC-4/8
State of California
Secretary of State
LIMITED LIABILITY COMPANY
SHORT FORM CERTIFICATE OF CANCELLATION
There is no fee for filing a Short Form Certificate of Cancellation.
IMPORTANT – Read instructions before completing this form.
This Space For Filing Use Only
FILE NUMBER
ENTITY NAME
(Enter the exact name of the domestic limited liability company.)
1. Secretary of State File Number
2. Name of Limited Liability Company
REQUIRED STATEMENTS
(The following statements should not be altered.)
3. a)
This Short Form Certificate of Cancellation is being filed within twelve (12) months from the date the Articles of Organization
were filed with the Secretary of State;
b)
The limited liability company does not have any debts or other liabilities, except as provided in Item 3(c);
c)
A final franchise tax return, as described by Section 23332 of the Revenue and Taxation Code, or a final annual tax return, as
described by Section 17947 of the Revenue and Taxation Code, has been or will be filed with the Franchise Tax Board, as required
under Part 10.2 (commencing with Section 18401) of Division 2 of the Revenue and Taxation Code.
d)
The limited liability company has not conducted any business from the time of the filing of the Articles of Organization; and
Payments received by the limited liability company for interests from investors, if any, have been returned to those investors.
e)
ASSETS
(Check the applicable statement. Note: Only one box may be checked.)
4.
The known assets of the limited liability company remaining after payment of, or adequately providing for, known debts and
liabilities have been distributed to the persons entitled thereto.
The limited liability company has acquired no known assets.
DISSOLUTION
(Check the applicable statement. Note: Only one box may be checked.)
5.
A majority of the members or managers of the limited liability company named in Item 2 has voted to dissolve the limited liability
company. The undersigned constitutes a majority of the members or a majority of the managers.
There are no members or managers. The sole person or a majority of the persons who signed the Articles of Organization of the
limited liability company named in Item 2 has voted to dissolve the limited liability company. The undersigned constitutes the sole
person or a majority of the persons who signed the Articles of Organization.
EXECUTION
(If additional signature space is necessary, the acknowledged signature(s) may be made on an attachment to this certificate. Any
attachments to this certificate are incorporated herein by this reference.)
6.
I declare I am the person who executed this instrument, which execution is my act and deed.
Signature of Member, Manager or Organizer
Type or Print Name of Member, Manager or Organizer
Signature of Member, Manager or Organizer
Type or Print Name of Member, Manager or Organizer
Signature of Member, Manager or Organizer
Type or Print Name of Member, Manager or Organizer
RETURN TO
(Enter the name and the address of the person or firm to whom a copy of the filed document should be returned.)
7.
NAME
FIRM
ADDRESS
CITY/STATE/ZIP
LLC-4/8 (REV 01/2013)
APPROVED BY SECRETARY OF STATE
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