Delaware Division of Corporations
401 Federal Street – Suite 4
Dover, DE 19901
Ph: 302-739-3073
Certificate of Cancellation
of a Limited Liability Company
Dear Sir or Madam:
Enclosed is the Certificate of Cancellation of a Limited Liability Company to be
filed in accordance with the Limited Liability Company Act of the State of Delaware.
The fee to file the Certificate is $200.00 and you will receive a stamped “Filed” copy of
your submitted document. A certified copy may be requested for an additional $50.
Expedited services are available. Please contact our office concerning these fees.
Please contact our Franchise Tax Section concerning any taxes due at the time of
cancellation. A check for the tax payment and filing fee must accompany the Certificate
for filing. Please make your check payable to the “Delaware Secretary of State”.
For the convenience of processing your order in a timely manner, please include a
cover letter with your name, address and telephone/fax number to enable us to contact
you if necessary. Please make sure you thoroughly complete all information requested on
this form. It is important that the execution be legible, we request that you print or type
your name under the signature line.
Thank you for choosing Delaware as your corporate home. Should you require
further assistance in this or any other matter, please don’t hesitate to call us at (302) 739-
Department of State
Division of Corporations
rev. 6/04
1. The name of the limited liability company is _____________________________
2. The Certificate of Formation of the limited liability company was filed on
IN WITNESS WHEREOF, the undersigned has executed this Certificate of
Cancellation this ____________day of _________________, A.D.________.
Authorized Person(s)
Print or Type