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Form Llc-1056 - Certificate Of Cancellation Of A Certificate Of Registration To Transact Business In Virginia As A Foreign Limited Liability Company

LLC-1056

COMMONWEALTH OF VIRGINIA

(10/03)

STATE CORPORATION COMMISSION

CERTIFICATE OF CANCELLATION

OF A CERTIFICATE OF REGISTRATION TO TRANSACT BUSINESS IN VIRGINIA

AS A FOREIGN LIMITED LIABILITY COMPANY

The name of the foreign limited liability company is

_______________________________________________________________.

The name of the state or country of formation is _________________________.

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

surrenders its registration to transact business in Virginia.

The 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.

The mailing address to which the Clerk of the Commission may mail a copy of

any process served on him as agent of the limited liability company is

_______________________________________________________________.

The 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)

____________________

(telephone number (optional))

_____________________

(limited liability company’s SCC ID No.)

SEE INSTRUCTIONS ON THE REVERSE

Form Llc-1056 - Certificate Of Cancellation Of A Certificate Of Registration To Transact Business In Virginia As A Foreign Limited Liability Company