COVER LETTER
TO: Registration Section
Division of Corporations
SUBJECT:
Name of Limited Liability Company
DOCUMENT NUMBER:
The enclosed Resignation of Registered Agent for a Limited Liability Company and fee are submitted
for filing.
Please return all correspondence concerning this matter to the following:
Name of Person
Name of Firm/Company
Address
City/State and Zip Code
E-mail address: (to be used for future annual report notification)
For further information concerning this matter, please call:
at ( )
Name of Person Area Code Daytime Telephone Number
Enclosed is a check made payable to the Florida Department of State for $85.00 for an active limited
liability company or $25.00 for an administratively dissolved, voluntarily dissolved or withdrawn
limited liability company.
Mailing Address: Street Address:
Registration Section Registration Section
Division of Corporations Division of Corporations
P.O. Box 6327 The Centre of Tallahassee
Tallahassee, FL 32314 2415 N. Monroe Street, Suite 810
Tallahassee, FL 32303
INHS17 (2/14)
STATEMENT OF RESIGNATION OF REGISTERED AGENT
FOR A LIMITED LIABILITY COMPANY
Pursuant to the provisions of section 605.0115, Florida Statutes, the undersigned,
, hereby resigns as
Name of Registered Agent
Registered Agent for
,
Name of Limited Liability Company
Document Number, if known
A copy of this resignation was mailed to the above listed limited liability company at its last known address.
The agency is terminated and the office discontinued on the 31st day after the date on which this statement is filed.
Signature of Resigning Agent
If signing on behalf of an entity:
Typed or Printed Name
Capacity
FILING FEES:
$ 85.00 Active limited liability company
$ 25.00 Administratively dissolved/ voluntarily dissolved/
withdrawn limited liability company
Make checks payable to Florida Department of State and mail to:
Division of Corporations
P.O. Box 6327
Tallahassee, FL 32314
INHS17 (2/14)