Form 562 - Filing Form Cover Letter Page 3
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5Form 562 Prescribed by:
For screen readers, follow instructions located at this path.
Certificate of Dissolution of Limited Liability Company /
Cancellation of Foreign Limited Liability Company
Filing Fee: $50
Form Must Be Typed
(CHECK ONLY ONE (1) BOX)
(1) Domestic Limited liability Company
(2) Foreign Limited liability Company
(For-profit or Nonprofit)
(For-profit or Nonprofit)
(140-LDS)
(131-LFS)
Jurisdiction of Formation
Name of Limited liability Company
If foreign, name of Limited Liability Company in its jurisdiction of formation (if different)
Ohio Registration Number
Complete the information in this section if box (1) is checked.
The Limited Liability Company hereby certifies that the effective date of the of the dissolution is:
Note: Effective date must be on or before the date of filing.
Complete the information in this section if box (2) is checked.
The undersigned limited liability company hereby certifies that it is no longer transacting business in the state of Ohio.
the authority of its registered agent to accept service of
The limited liability company
process, notices and demands on its behalf.
(Please enter 'does revoke' or 'does not revoke')
If the authority of the agent is revoked then please provide the address to which a person may mail copy of an process,
notice, or demand against the company is:
Mailing Address
City
ZIP Code
State
If this mailing address changes in the future, the limited liability company hereby agrees to notify the Ohio Secretary of State
of such change.
Last Revised: 10/01/2017
Form 562
Page 3 of 5
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