Form Dscb:15-8832 - Certificate Of Authority/amendment/cancellation Page 4
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4Check the box. List the date that the Certificate of Company
Authority that is being canceled became effective.
Signature and Verification
An authorized representative of the limited liability
company must sign the Certificate of Company Authority
(or amendment or cancellation thereto).
Signing a
document delivered to the Department for filing is an
affirmation under the penalties provided in 18 Pa.C.S. §
4904 (relating to unsworn falsification to authorities) that
the facts stated in the document are true in all material
respects.
This field is required.
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