Form Mllc-12b - Statement Of Cancellation Of Foreign Qualification
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2Filing Fee $90.00
LIMITED LIABILITY COMPANY
STATE OF MAINE
STATEMENT OF CANCELLATION OF
FOREIGN QUALIFICATION
_____________________
(for a Foreign LLC)
Deputy Secretary of State
A True Copy When Attested By Signature
______________________________________
_____________________
(Name of Limited Liability Company in Jurisdiction of Organization)
Deputy Secretary of State
Pursuant to
31 MRSA
§1628, the undersigned foreign limited liability company hereby cancels its statement of qualification in the State
of Maine and states the following:
FIRST:
If different, the fictitious name under which the limited liability company adopted to do business in the State of Maine
pursuant to
§1510-1.B
is:
_______________________________________________________________________________________________
SECOND:
Its jurisdiction of organization is _____________________________ (state or country) and the date of organization
is _____________________________.
THIRD:
The date on which the foreign limited liability company was qualified to conduct activities in the State of
Maine:________________________________.
FOURTH:
The foreign limited liability company will no longer conduct business in the State of Maine and it relinquishes its
authority to conduct business and is cancelling its statement of foreign qualification.
FIFTH:
If the foreign limited liability company is not maintaining the registered agent in the State of Maine, the mailing address
to which service of process may be mailed pursuant to
§1662
is:
____________________________________________________________________
(
Principal office address)
____________________________________________________________________
(
Principal office address)
SIXTH:
The street and mailing address of the foreign limited liability company’s principal office is:
_______________________________________________________________________________________________
(street, city, state and zip code)
Form No. MLLC-12B (1 of 2)
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