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DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.
NOTICE OF CANCELLATION OF APPROVED
LIMITED LIABILITY COMPANY NAME RESERVATION
L003i
Read the Instructions
1.
NAME THAT WAS RESERVED - enter the exact name:
_______________________________________________________________________
2.
A.C.C. FILE NUMBER: ___________________________________________________________
Find the A.C.C. file number on the upper corner of filed documents OR on our website at:
3. OWNER – give the name and address of the owner of the reserved name – this is individual or
entity listed as the Applicant in the Application to Reserve Limited Liability Company Name or the
individual or entity to whom the name reservation was transferred (Transferee) if a Notice of
Transfer was filed:
Name
Address 1
Address 2 (optional)
City
State or Province
Zip
Country
SIGNATURE:
By my signature appearing below, I am requesting cancellation of the name
reservation listed in the number 1 above.
By checking the box marked "I accept" below, I acknowledge under penalty
of perjury that this document together with any attachments is submitted in
compliance with Arizona law.
I ACCEPT
Signature
Printed Name
Date (mm/dd/yy)
REQUIRED – check only one:
I am the Owner (and I am an individual
The Owner is an entity and I am its duly
or natural person and not an entity).
authorized agent.
Mail:
Arizona Corporation Commission
Filing Fee: $10.00 (regular processing)
Corporate Filings Section
Expedited processing – add $35.00 to filing fee.
1300 W. Washington St., Phoenix, Arizona 85007
All fees are nonrefundable - see Instructions.
Fax:
602-542-4100
Please be advised that A.C.C. forms reflect only the minimum provisions required by statute. You should seek private legal counsel for those matters that may pertain
to the individual needs of your business.
All documents filed with the Arizona Corporation Commission are public record and are open for public inspection.
If you have questions after reading the Instructions, please call 602-542-3026 or (within Arizona only) 800-345-5819.
L003.001
Arizona Corporation Commission – Corporations Division
Rev: 2010
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