Form Llc 4 7 – Fill Out and Use This PDF

Secretary of State

Business Programs Division

Business Entities

1500 11th Street, Sacramento, CA 95814

P.O. Box 944260, Sacramento, CA 94244-2600

Submission Cover Sheet

For faster service, file online at bizfileOnline@sos.ca.gov.

Instructions:

•Complete and include this form with your paper submission. This information only will be used to communicate with you about the submission, if needed. This form will be treated as correspondence and will not be made part of the filed document.

•Make all checks or money orders payable to the Secretary of State.

•In person submissions (excluding Statements of Information): $15 handling fee; do not include a $15 handling fee when submitting documents by mail.

•Standard processing time for submissions to this office is approximately 5 business days from receipt. All submissions are reviewed in the date order of receipt with online submissions given priority. For updated processing time information, visit www.sos.ca.gov/business/be/processing-dates.

Optional Copy and Certification Fees:

•If applicable, include optional copy and certification fees with your submission.

•For applicable copy and certification fee information, refer to the instructions of the specific form you are submitting.

Contact Person: (Please type or print legibly)

Phone (optional):

Entity Information: (Please type or print legibly)

Name:

Entity Number (if applicable):

Comments:

Certificate of Cancellation

Limited Liability Company (LLC)

There is No Fee for filing a Certificate of Cancellation

Certification Fee (Optional) – $5.00

This Space For Office Use Only

1.Limited Liability Company Name (Enter the exact name of the LLC as it is recorded with the California Secretary of State)

2.LLC 12-Digit Entity (File) Number (Enter the exact 12-digit Entity (File) Number issued by the California Secretary of State.)

3.Dissolution (California LLCs ONLY: Check the box if the vote to dissolve was made by the vote of ALL the members.)

The dissolution was made by a vote of ALL of the members of the California Limited Liability Company.

Note: If the above box is not checked, a Certificate of Dissolution (Form LLC-3) must be filed prior to or together with this Certificate of Cancellation. (California Corporations Code section 17707.08(a).)

4.Tax Liability Statement (Do not alter the Tax Liability Statement.)

All final returns required under the California Revenue and Taxation Code have been or will be filed with the California Franchise Tax Board.

5.Cancellation Statement (Do not alter the Cancellation Statement.)

Upon the effective date of this Certificate of Cancellation, the Limited Liability Company’s registration is cancelled and its powers, rights and privileges will cease in California.

6.Read and Sign Below (Do not use a computer generated signature.)

By signing, I affirm under penalty of perjury that the information herein is true and correct and that I am authorized by California law to sign.