State of North Carolina
State of North Carolina Department of the Secretary of State CERTIFICATE OF CANCELLATION Registered Limited Liability Partnership
Pursuant to ?59-84.2(j) or ? 59-91(k) of the General Statutes of North Carolina, as applicable, the undersigned hereby submits this Certificate of Cancellation for the purpose of cancelling its registration as a domestic or foreign Registered Limited Liability Partnership.
1. The name of the partnership as reflected on the application for registration: ___________________________________________________________________________________________
2. The date of filing of the application for registration that is to be cancelled:________________________________ 3. The Secretary of State may mail a copy of any process served on the Secretary of State to the following mailing
address:_____________________________________________________________________________________ __________________________________________________. A statement of any subsequent change in the mailing address identified above will be filed with the Secretary of State. 4. This cancellation will be effective upon filing, unless a date and/or time is specified: _______________________
This the _______day of _______________, 20________.
_______________________________________
_______________________________________ Signature _______________________________________ Type or Print Name and Title
Note: The filing fee for this document is $25.00.
BUSINESS REGISTRATION DIVISION (Revised August, 2017)
P.O.BOX 29622
RALEIGH, NC 27626-06222 Form LLP-04
Instructions for Completing Certificate of Cancellation (Form LLP-04)
1. This application must be executed by one or more partners.
2. The original executed Certificate of Cancellation, along with the $25.00 filing fee, should be filed with the Corporations Division at the address below:
Department of the Secretary of State Post Office Box 29622 Raleigh, North Carolina 27626-0622
3. If the Certificate of Cancellation is properly completed, the Secretary of State will file the Certificate and return a conformed copy stamped with the effective date of filing.
BUSINESS REGISTRATION DIVISION (Revised August, 2017)
P.O.BOX 29622
RALEIGH, NC 27626-06222 Form LLP-04
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