Print Form Reset Form District of Columbia Government Corporations Division Application for Cancellation of Registration for Foreign Limited Liability Company Form FLC-4, Version 2, July 2010. Use this form (FLC-4) to cancel certificate of registration for a foreign limited liability company from the District of Columbia. ENTITY TYPE Foreign Limited Liability Company FILING FEE Refer to Corporate Fee Schedule posted online; Under the provisions of the Limited Liability Company Act, DC Official Code Title 29 Chapter 10, the undersigned limited liability company hereby proposes to cancel its certificate to transact business in the District of Columbia, and for that purpose submits the following: 1. Entity Name: 2. State or country whose laws govern Entity's Formation: 3. By signing this form, you affirm that the Corporation: • Is not transacting business in the District of Columbia and surrenders its authority to transact business in the District. • Revokes the authority of its registered agent in the District to accept service of process and consents that that service in any suit, action or proceeding based on any cause of action in the District while the company was authorized to transact business in the District, may from now on -- be made on the company by service on the DC Superintendent of Corporations. • Have paid all sums due, or owed in the District of Columbia, or adequate provision has been made for the payment thereof. • Have paid or provided for all known creditors or claimants and is not involved in or threatened with litigation in any court in the District of Columbia. 4. Mailing address where the Superintendent of Corporations may mail any process against the company it may be served (must be company's main office address): 5. Select Company Representative executing this form: Manager Member 6. Signature: Authorized Person If you sign this application, you agree that you understand that anyone who makes a false statement anywhere on it can be punished by criminal penalties of a fine up to $1000, imprisonment up to 180 days, or both, under DCOC § 22-2405. Mail all forms and required payment to: Department of Consumer and Regulatory Affairs Corporations Division PO Box 92300 Washington, DC 20090 Phone: (202) 442-4400 Please check dcra.dc.gov to view organizations required to register, to search business names, to get step-by-step guidelines to register an organization, to search registered organizations, and to download forms and documents. Just click on "Corporate Registrations." American LegalNet, Inc. www.FormsWorkFlow.com