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Application For Certificate Of Cancellation Form. This is a Iowa form and can be use in Business Organizations Secretary Of State.
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Tags: Application For Certificate Of Cancellation, 635_0125, Iowa Secretary Of State, Business Organizations
MICHAEL A. MAURO
Secretary of State
State of Iowa
APPLICATION FOR
CERTIFICATE OF
CANCELLATION
TO THE SECRETARY OF STATE OF THE STATE OF IOWA:
Pursuant to section 1406 of the Iowa Limited Liability Companies Act, the undersigned limited liability company
applies for a certificate of cancellation from Iowa, and states:
1. The name of the Limited Liability Company: __________________________________________
and the name the Limited Liability Company uses in Iowa if different than its real name:
____________________________________________________________________________
2. The Limited Liability Company is formed under the laws of the state [or foreign country] of:
____________________________________________________________________________
3. The Limited Liability Company is not transacting business in Iowa and surrenders its authority to transact
business in Iowa.
4. The Limited Liability Company revokes the authority of its registered agent to accept service on its
behalf and appoints the Secretary of State as its agent for service of process in any proceeding based
on a cause of action arising during the time it was authorized to transact business in Iowa.
5. The mailing address to which the Secretary of State may mail a copy of any process served on the
Secretary of State is:
Name ________________________________________________________________________
Address ______________________________________________________________________
City, State, ZIP ________________________________________________________________
(The Limited Liability Company will notify the Secretary of State of any changes in this mailing address.)
Signature _________________________________________________ Date ________________
Type or print name and title _______________________________________________________
The filing fee is $10.00.
635_0125
rev. 04/07
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NOTES:
1. The filing fee is $10.00. Make checks payable to Secretary of State.
2. The application is to be signed by the manager. If a manager has not been selected, the application should be
signed by the person forming the Limited Liability Company. If the Limited Liability Company is in the hands of
a court appointed fiduciary, the application needs to be signed by the fiduciary. A copy of a signature is
acceptable for filing.
3. One copy of the document is to be delivered to the Secretary of State for filing.
4. The effective time and date of the document is the later of the following:
a. the time of filing on the date it is filed;
b. the time specified in the document on the date it is filed;
c. the time and date specified in the document, not later than 90 days after the date it is filed.
5. The information you provide will be open to public inspection under Iowa Code section 22.11.
SECRETARY OF STATE
Business Services Division
Lucas Building, 1st Floor
Des Moines, Iowa 50319
Phone: (515) 281-5204
FAX: (515) 281-7142 or (515) 242-5953
Website: www.sos.state.ia.us
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