INSTRUCTIONS – CERTIFICATE OF CANCELLATION
Please complete all sections of the Certificate of Cancellation. USE DARK INK ONLY. For an electronic,
fillable version of this form, please visit our website at
Section 1
Provide the Limited Liability Company (LLC) name as it is currently is recorded with the Office of the Secretary
of State.
Section 2
Select the type of Limited Liability Company either Domestic (formed inside Washington State) or Foreign
(formed outside Washington State) as registered with the Office of the Secretary of State.
Section 3
List the original filing date of the Limited Liability Company’s Certificate of Formation/Registration as recorded
with the Office of the Secretary of State.
Section 4
Choose either upon filing by the Secretary of State or you may indicate an effective date. The effective date
can be up to 90 days AFTER filing the cancellation of the Certificate of Formation by the Office of the Secretary
of State.
Section 5
Section 5 is for Foreign Limited Liability Companies ONLY. A Foreign LLC must complete this section with an
address where service of process may be forwarded.
Section 6
List the reason(s) for cancellation of the Limited Liability Company. (
if necessary, attach additional information)
Section 7
The Certificate of Cancellation must be signed by a member or manager of the LLC or their authorized
representative. If signed by an authorized representative you must provide the title and capacity of person
signing and whom they represent.
Additional Information:
UBI Number: Please enter your existing Unified Business Identifier (UBI Number) as currently recorded with
the Office of the Secretary of State, in the box in the upper right hand corner of page 1.
FEES: There is no filing fee for standard service. If expedited service is requested, include an additional
$20.00 and write “EXPEDITE” on the outside of the envelope. Make the checks or money orders payable to
“Secretary of State”. (Effective March 26, 2009 ALL fees are non-refundable)
Mail completed forms and payment to:
Secretary of State
Corporation Division
801 Capitol Way S
PO Box 40234
Olympia WA 98504-0234
If you have questions, need assistance, or would like to provide feedback please visit the Corporations
Division website at
or call 360-725-0377.
Print Form
LLC - Cancellation
Washington Secretary of State
Revised 02/09