Certificate Of Dissolution (Domestic/wa) - Limited Liability Company
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Limited Liability Company
See attached detailed instructions
□
No Fee for Standard Service
□
Expedited Service $50.00
UBI Number:
CERTIFICATE OF DISSOLUTION (Domestic/WA)
Chapter 25.15 RCW
SECTION 1
:
NAME OF LIMITED LIABILITY COMPANY
(as currently recorded with the Office of the Secretary of State)
MAILING ADDRESS TO RETURN THE COMPLETED DOCUMENT:
_______________________________________________________________
City
State
Zip Code
SECTION 2
ORIGINAL DATE FOR CERTIFICATE OF FORMATION:
SECTION 3
REASON FOR DISSOLUTION:
(if necessary, attach additional information)
SECTION 4
EFFECTIVE DATE OF DISSOLUTION:
(please check one of the following)
□
Upon filing by the Secretary of State
□
Specific Date: __________________
(Specified effective date must be within 90 days AFTER the Dissolution
has been filed by the Office of the Secretary of State)
SECTION 5
MEMBER OR MANAGER SIGNATURE
(see instructions page)
This document is hereby executed under penalties of perjury, and is, to the best of my knowledge, true and correct.
X_______________________________________________________________________________________
Signature
Printed Name/Title
Date
Phone
LLC - Dissolution
Washington Secretary of State
Revised 03/13
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