Page 1 of 4Form 562Last Revised: 06/2019 Toll Free: 877.767.3453 | Central Ohio: 614.466.3910 OhioSoS.gov | business@OhioSoS.gov File online or for more information: OhioBusinessCentral.gov Filing Form Cover LetterPlease return the approval certificate to: Address: City: ZIP Code: Phone Number: E-mail Address: Check here if you would like to receive important notices via e-mail from the Ohio Secretary of State's office regarding Business Services. Check here if you would like to be signed up for our Filing Notification System for the business entity being created or updated by filing this form. This is a free service provided to notify you via e-mail when any document is filed on your business record. Please make checks or money orders payable to: "Ohio Secretary of State" Type of Service Being Requested: (PLEASE CHECK ONE BOX BELOW) Regular Service: Only the filing fee listed on page one of the form is required and the filing will be processed in approximately 3-7 business days. The processing time may vary based on the volume of filings received by our office. Expedite Service 1: By including an Expedite fee of $100.00, in addition to the regular filing fee on page one of the form, the filing will be processed within 2 business days after it is received by our office. Expedite Service 2: By including an Expedite fee of $200.00, in addition to the regular filing fee on page one of the form, the filing will be processed within 1 business day after it is received by our office. This service is only available to walk-in customers who hand deliver the document to the Client Service Center. Expedite Service 3: By including an Expedite fee of $300.00, in addition to the regular filing fee on page one of the form, the filing will be processed within 4 hours after it is received by our office, if received by 1:00 p.m. This service is only available to walk-in customers who hand deliver the document to the Client Service Center. Preclearance Filing: A filing form, to be submitted at a later date for processing, may be submitted to be examined for the purpose of advising as to the acceptability of the proposed filing for a fee of $50.00. The Preclearance will be complete within 1-2 business days. Name (Individual or Business Name): To the Attention of (if necessary): State American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 4Form 562Last Revised: 06/2019Toll Free: 877.767.3453 Central Ohio: 614.466.3910 OhioSoS.gov business@OhioSoS.gov File online or for more information: OhioBusinessCentral.gov Mail this form to one of the following: Regular Filing (non expedite) P.O. Box 1329 Columbus, OH 43216 Expedite Filing (Two business day processing time. Requires an additional $100.00) P.O. Box 1390 Columbus, OH 43216 Form 562 Prescribed by:Certificate of Dissolution of Limited Liability Company / Cancellation of Foreign Limited Liability Company Filing Fee: $50 Form Must Be Typed (CHECK ONLY ONE (1) BOX) (1) Domestic Limited liability Company (For-profit or Nonprofit) (140-LDS) (2) Foreign Limited liability Company (For-profit or Nonprofit) (131-LFS) Jurisdiction of Formation Name of Limited liability Company If foreign, name of Limited Liability Company in its jurisdiction of formation (if different) Ohio Registration NumberComplete the information in this section if box (1) is checked. The Limited Liability Company hereby certifies that the effective date of the of the dissolution is:Note: Effective date must be on or before the date of filing.The undersigned limited liability company hereby certifies that it is no longer transacting business in the state of Ohio.The limited liability companythe authority of its registered agent to accept service of process, notices and demands on its behalf. If the authority of the agent is revoked then please provide the address to which a person may mail copy of an process, notice, or demand against the company is: If this mailing address changes in the future, the limited liability company hereby agrees to notify the Ohio Secretary of State of such change.Complete the information in this section if box (2) is checked.(Please enter 'does revoke' or 'does not revoke') Mailing Address City ZIP Code State For screen readers, follow instructions located at this path. American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 4Form 562Last Revised: 06/2019 Print Name By (if applicable) Signature Print Name By (if applicable) Signature Print Name By (if applicable) SignatureBy signing and submitting this form to the Ohio Secretary of State, the undersigned hereby certifies that he or she has the requisite authority to execute this document.Required Must be signed by an authorized representative. If the authorized representative is an individual, then they must sign in the "signature" box and print his/her name in the "Print Name" box. If the authorized representative is a business entity, not an individual, then please print the entity name in the "signature" box, an authorized representative of the business entity must sign in the "By" box and print his/her name and title/authority in the "Print Name" box. American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 4Form 562Last Revised: 06/2019Instructions for Certificate of Dissolution of Limited Liability Company/Cancellation of Foreign Limited Liability CompanyThis form should be used to file a Certificate of Dissolution of a Domestic Limited Liability Company pursuant to Ohio Revised Code 2471705.43 or to file a Cancellation of a Foreign Limited Liability Company pursuant to Ohio Revised Code 2471705.57. Please select the appropriate box to indicate whether the entity is a domestic or foreign limited liability company. If foreign, please provide the jurisdiction of formation in the space provided. Limited Liability Company Information The dissolution/cancellation must set forth the name of the company and the Ohio registration number. If the company is a foreign company, then provide the name under which the company is registered in this state and, if different, the name under which it is registered or organized in its jurisdiction of formation. Domestic Limited Liability Company Effective Date A domestic limited liability company must provide the effective date of the dissolution pursuant to Ohio Revised Code 2471705.43(B). The effective date must be the date of filing or a prior date. Future effective dates are not permissible under ORC 2471705.43(B). Foreign Limited Liability Company By signing this form the foreign entity agrees to the statement on the form which states that the company is not transacting business in Ohio. Pursuant to Ohio Revised Code 2471705.57(C), please complete the blank in the second statement to indicate whether the authority of its statutory agent in Ohio to accept service of process, notices, and demands is revoked or not revoked. If it is revoked, provide an address to which a person may mail a copy of any process, notice, or demand against the company. Furthermore, by signing this form the foreign entity agrees to the final statement which states that the company agrees to notify our office in the future of any change in the mailing address provided. Signature(s) After completing all information on the filing form, please make sure that page 2 is signed by at least one authorized representative of the limited liability company. American LegalNet, Inc. www.FormsWorkFlow.com