PHOENIX OFFICE TUCSON OFFICE 1300 West Washington Phoenix, Arizona 85007-2929 Phone: (602) 542-3026 Toll Free (AZ only): 1-800-345-5819 400 West Congress, Suite #221 Tucson, Arizona 85701-1347 Phone: (520) 628-6560 Toll Free (AZ only): 1-800-345-5819 www.azcc.gov ARIZONA CORPORATION COMMISSION CORPORATIONS DIVISION www.azcc.gov GENERAL FILING INSTRUCTIONS FOR CERTIFICATE OF CANCELLATION OF APPLICATION FOR REGISTRATION Pursuant to A.R.S. § 29-808  Deliver two (2) completed copies of the signed original Certificate of Cancellation to the Commission. Your filed copy will be returned to you when all of the requirements have been satisfied. Notarization is not required.  The Certificate of Cancellation must be signed and acknowledged by a manager, member or authorized agent.  Pay the required fee of $10.00. Expedited service is available for an additional $35.00 (add $35 to the filing fee). Please make check payable to the Arizona Corporation Commission.  If the person executing the documents has a power of attorney authorizing him/her to do so, a copy of the document granting authority must be included with the filing. Certificate of Cancellation:  Indicate the exact name of the limited liability company in Arizona including identifier (i.e. LLC).  Indicate the address of the organization in its jurisdiction to which the Arizona Corporation Commission can forward service of process. Publication:  Publication is not required. LL:0009 Rev: 09/2009 Arizona Corporation Commission Corporations Division American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF CANCELLATION OF APPLICATION FOR REGISTRATION Pursuant to A.R.S. § 29-808 1. The name of the foreign limited liability company is: ___________________________________________________________________________. 2. The company was formed under the laws of the State of ______________________. 3. The cancellation does not terminate the authority of the commission to accept service of process on the foreign limited liability company with respect to causes of action arising out of the transactions of business in this state. 4. The address of the organization in its jurisdiction to which the Arizona Corporation Commission can forward service of process is: _____________________________________________________________________ ____________________________________________________________________ _____________________________________________________________________ Dated this day of , . Signature: _________________________________________________ (Check one) Member Manager Authorized Agent Print Name: _______________________________________________ __________________________________________________________ If signing on behalf of a company, please print company name here. LL:0009 Rev: 09/2009 Arizona Corporation Commission Corporations Division American LegalNet, Inc. www.FormsWorkFlow.com