CERTIFICATE OF CANCELLATION , DOMESTIC AND FOREIGN LIMITED
(Rev 7/01/02)
Instructions for Form L-109 CERTIFICATE OF CANCELLATION DOMESTIC AND FOREIGN LIMITED LIABILITY COMPANIES
(Title 42:2B)
STATUTORY FEE: $100 for Domestic; $125 for Foreign LLC The MANDATORY fields are:
Field # 1 -- Business Name List the name as it appears on the records of the Treasurer.
Field # 2 -- Date Of Formation List the date the LLC was formed.
Field # 4 -- Reason For Filing Specify the reason for filing the cancellation.
ATTESTATIONS Add a statement that indicates that the signers are authorized to sign on behalf of the LLC. Form L-109 provides the statement.
EXECUTION (DATE/SIGNATURE) An authorized representative must sign. Also, list the date of execution (signature).
* * * * * * * * * * * * * * * * These documents should be filed in duplicate. Non-profits should file in triplicate. Make checks payable to: TREASURER, STATE OF NEW JERSEY. (No cash, please)
Mail to: NJ Division of Revenue, PO Box 308, Trenton, NJ 08625
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