Form Llf-9 - Certificate Of Cancellation Of Authority Of A Foreign Limited Liability Company 2013

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Natalie E. Tennant
Penney Barker, Manager
Secretary of State
Corporations Division
1900 Kanawha Blvd E.
Tel: (304)558-8000
Bldg 1, Suite 157-K
Fax: (304)558-8381
Charleston, WV 25305
Website:
E-mail:
CERTIFICATE OF CANCELLATION
FILE ONE ORIGINAL
OF AUTHORITY OF A FOREIGN
Office Hrs: Monday - Friday
(Two if you want a filed
8:30 a.m. – 5:00 p.m. ET
stamped copy returned to you)
LIMITED LIABILITY COMPANY
FEE: $25.00
Pursuant to West Virginia Code §31B-10-1008:
1. The name of the limited liability
_______________________________________________
company is:
and is organized in the State of:
_______________________________________________
2. The address to which correspondence
_______________________________________________
relating to this cancellation is to be sent:
_______________________________________________
3. The effective date of the cancellation of
the date the certificate of cancellation is filed
authority of the above named limited
liability company is:
the following date: ________________________
(requested date may not be earlier than filing nor later
than 90 days after filing in our office)
4. Contact name and phone number to reach in case of a problem with filing: (Optional, however,
listing one may help to avoid a return or rejection of filing if there is a problem with the document.)
____________________________________________ ____________________________________
Contact Name
Phone Number
Business e-mail address, if any: _______________________________________________________
5. I, the undersigned, hereby certify that: (1) I am authorized to act on behalf of the limited liability
company in this matter; (2) this foreign limited liability company has ceased to do business in West
Virginia; and (3) all responsibilities for filing with the Department of Tax and Revenue and any other
State agencies have been completed.
____________________________________________ _________________________
Name (print)
Title/Capacity
____________________________________________ _________________________
Signature*
Date
*Important Legal Notice Regarding Signature: Per West Virginia Code §31B-2-209. Liability for false
statement in filed record. If a record authorized or required to be filed under this chapter contains a false statement,
one who suffers loss by reliance on the statement may recover damages for the loss from a person who signed the
record or caused another to sign it on the person's behalf and knew the statement to be false at the time the record
was signed.
Form LLF-9
Issued by the Office of the Secretary of State
Revised 5/13

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