Form Mllc-9a - Statement Of Withdrawal Of Member - Maine Secretary Of State
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1Filing Fee $20.00
DOMESTIC
LIMITED LIABILITY COMPANY
STATE OF MAINE
Deputy Secretary of State
STATEMENT OF WITHDRAWAL
OF MEMBER
A True Copy When Attested By Signature
______________________________________
Deputy Secretary of State
(Name of Limited Liability Company)
Pursuant to 31 MRSA §694, the undersigned member OR limited liability company executes and delivers for filing this statement of
withdrawal of member:
The following member has withdrawn from the above-named limited liability company.
________________________________________________________________________
(type or print name)
DATED __________________________
WITHDRAWING MEMBER
___________________________________________________
____________________________________________________
(signature)
(type or print name)
The following may be completed by the limited liability company, if the withdrawing member did not sign.*
MANAGER(S)/MEMBER(S)*
___________________________________________________
____________________________________________________
(signature)
(type or print name and capacity)
Name of Entity __________________________________________________________________________________________________
By ________________________________________________
____________________________________________________
(authorized signature)
(type or print name and capacity)
*Statement MUST be signed by
(1) at least one manager OR
(2) at least one member if the limited liability company is managed by the members OR
(3) any duly authorized person.
The execution of this certificate constitutes an oath or affirmation under the penalties of false swearing under Title 17-A, section 453.
A statement of withdrawal of a member is an optional filing. It may be used to cut off the ability of a withdrawing member to
bind the limited liability company, particularly in a member-managed limited liability company.
SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE,
101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101
FORM NO. MLLC-9A
Rev. 4/16/2001
TEL. (207) 624-7740
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