Form Ss 4241 is an information form used to collect data on Social Security benefits. The form can be used by individuals, employers, or other third parties who need information about a person's Social Security benefits. The form requests a variety of information, including the person's name, Social Security number, type of benefit, and amount of benefit. The form can be used to request information on any type of Social Security benefit, including retirement, disability, or survivor benefits.
| Question | Answer |
|---|---|
| Form Name | Form Ss 4241 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | transact, tn form ss 4241, revokes, Snodgrass |
Corporate Filings
312 Rosa L. Parks Avenue
6th Floor, William R. Snodgrass Tower
Nashville, TN 37243
APPLICATION FOR CANCELLATION OF CERTIFICATE OF AUTHORITY
(LIMITED LIABILITY COMPANY)
For Offi ce Use Only
To the Secretary of State of the State of Tennessee:
Pursuant to the provisions of
1. The name of the Limited Liability Company is
.
If different, the name under which the certifi cate of authority was obtained is
.
2. The state or country under whose law it is organized is |
. |
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3.The Limited Liability Company is not transacting business in the State of Tennessee and surrenders its authority to transact business in this state.
4.Please mark/complete the applicable statement:
The Limited Liability Company continues its registered agent and registered offi ce in the State of Tennessee.
The Limited Liability Company hereby 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 this state. The mailing address (including zip code) to which the Secretary of State may mail a copy of any process served on him is:
.
5.The undersigned Limited Liability Company makes the commitment to notify the Secretary of State in the future of any change in its mailing address.
_______________________________________ |
______________________________________________ |
Signature Date |
Name of Limited Liability Company |
__________________________________________ |
______________________________________________ |
Signer’s Capacity |
Signature |
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_____________________________________________ |
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Name (typed or printed) |
Filing Fee: $20 |
RDA 2458 |