Form 452 - Certificate Of Cancellation Of Registration Of Foreign Limited Liability Company - 2012

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Filing Fee: $75.00
ID Number: ____________
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Office of the Secretary of State
Division of Business Services
148 W. River Street
Providence, Rhode Island 02904-2615
LIMITED LIABILITY COMPANY
_____________
CERTIFICATE OF CANCELLATION OF
REGISTRATION OF FOREIGN LIMITED LIABILITY COMPANY
Pursuant to the provisions of Section 7-16-53 of the General Laws of Rhode Island, 1956, as amended, the undersigned
foreign limited liability company hereby cancels its registration to transact business in the State of Rhode Island, and for
that purpose submits the following statement:
1. The name of the limited liability company is:
2. It is organized under the laws of
3. It is not transacting business in the state of Rhode Island.
4. It hereby surrenders its authority to transact business in the state of Rhode Island.
5. It confirms the authority of the Secretary of State of the State of Rhode Island to accept service of process with
respect to claims for relief or causes of action arising out of the transaction of business in Rhode Island.
6. The post office address to which the Secretary of State may mail a copy of any process against the limited liability
company that may be served on him or her is:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
7. The date this Certificate of Cancellation is to become effective, if later than the date of filing, is:
(not prior to, nor more than 30 days after, the filing of this Certificate of Cancellation)
Under penalty of perjury, I declare and affirm that I have
examined this Certificate of Cancellation of Registration and that
all statements contained herein are true and correct.
Date:
Print Exact Name of Limited Liability Company
By
Signature of Authorized Person
Form No. 452
Revised: 05/12

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