State of North Carolina
Department of the Secretary of State
CERTIFICATE OF CANCELLATION
Registered Limited Liability Partnership
Purs
uant to §59-84.2(j) or § 59-91(k) of the General Statutes of North Carolina, as applicable, the undersigned
hereby submits this Certificate of Cancellation for the purpose of cancelling its registration as a domestic or foreign
Registered Limited Liability Partnership.
1. T
he name of the partnership as reflected on the application for registration:
_________
__________________________________________________________________________________
2. T
he date of filing of the application for registration that is to be cancelled:________________________________
3. The Secretary of State may mail a copy of any process served on the Secretary of State to the following mailing
address:_____________________________________________________________________________________
__________________________________________________. A statement of any subsequent change in t
he
mailing address identified above will be filed with the Secretary of State.
4.
This cancellation will be effective upon filing, unless a date and/or time is specified: _______________________
This the _______day of _______________, 20________.
_________
______________________________
_______________________________________
Signature
_________
______________________________
Type or Print Name and Title
N
ote: The filing fee for this document is $25.00.
BUSINESS REGISTRATION DIVISION P.O.BOX 29622 RALEIGH, NC 27626-06222
(Revised August, 2017) Form LLP-04
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Instructions for Completing Certificate of Cancellation
(Form LLP-04)
1. This application must be executed by one or more partners.
2. The original executed Certificate of Cancellation, along with the $25.00 filing fee, should be filed with
the Corporations Division at the address below:
Department of the Secretary of State
Post Office Box 29622
Raleigh, North Carolina 27626-0622
3. If the Certificate of Cancellation is properly completed, the Secretary of State will file the Certificate
and return a conformed copy stamped with the effective date of filing.
BUSINESS REGISTRATION DIVISION P.O.BOX 29622 RALEIGH, NC 27626-06222
(Revised August, 2017) Form LLP-04