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Form Llc-1056 - Certificate Of Cancellation Of A Certificate Of Registration As A Foreign Limited Liability Company

COMMONWEALTH OF VIRGINIA

STATE CORPORATION COMMISSION

CERTIFICATE OF CANCELLATION

LLC-1056

OF A CERTIFICATE OF REGISTRATION AS A

(04/08)

FOREIGN LIMITED LIABILITY COMPANY

The undersigned, on behalf of the limited liability company set forth below, pursuant to § 13.1-1056

of the Code of Virginia, states as follows:

1. The name of the foreign limited liability company is

_______________________________________________________________________.

2. The name of the state or other jurisdiction of formation is _________________________.

3. The foreign limited liability company is not transacting business in Virginia and it

surrenders its registration to transact business in Virginia.

4. The foreign limited liability company revokes the authority of its registered agent to accept

service of process on its behalf and appoints the Clerk of the Commission as its agent for

service of process in any proceeding based on a cause of action arising during the time it

was authorized to transact business in Virginia.

5. The mailing address to which the Clerk of the Commission may mail a copy of any process

served on him as agent of the foreign limited liability company is

_______________________________________________________________________.

6. The foreign limited liability company commits to notify the Clerk of the Commission in the

future of any change in its mailing address.

Executed in the name of the foreign limited liability company by:

____________________________________________

_______________________

(signature of authorized person)

(date)

____________________________________________

_______________________

(printed name)

(title (e.g., manager or member))

____________________________________________

_______________________

(limited liability company’s SCC ID No.)

(telephone number (optional))

PRIVACY ADVISORY: Information such as social security number, date of birth, maiden name, or financial institution account numbers is NOT required to be included

in business entity documents filed with the Office of the Clerk of the Commission. Any information provided on these documents is subject to public viewing.

SEE INSTRUCTIONS ON THE REVERSE

Provide a name and mailing address for sending correspondence regarding the filing of this document. (If left

blank, correspondence will be sent to the registered agent at the registered office.)

(name)

(mailing address)