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Application For Certificate Of Withdrawal Of Foreign Master LLC {56272}
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Description
APPLICATION FOR CERTIFICATE OF WITHDRAWAL OF A FOREIGN MASTER LIMITED LIABILITY COMPANY State Form 56272 (3-17) Approved by State Board of Accounts, 2017 SECRETARY OF STATE BUSINESS SERVICES DIVISION 302 West Washington Street, Room E018 Indianapolis, IN 46204 Telephone: (317) 232-6576 www.sos.in.gov INSTRUCTIONS: 1. Use 8 ½" x 11" white paper for attachments. 2. Please TYPE or PRINT in INK. 3. Please visit our office on the web at www.sos.IN.gov 4. Make check or money order payable to the Secretary of State. 5. Submit original completed paperwork and payment to: 302 West Washington Street, Room E-018, Indianapolis, IN 46204. INFORMATION CONTAINED ON THIS PAGE IS NOT PART OF THE PUBLIC RECORD. Name of business E-mail address of business (SOS use only) RETURN DOCUMENTS TO: Name Street address, line 1 Street address, line 2 City State ZIP code Telephone number E-mail address (If different from above SOS use only) ( ) American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION FOR CERTIFICATE OF WITHDRAWAL OF A FOREIGN MASTER LIMITED LIABILITY COMPANY State Form 56272 (3-17) Approved by State Board of Accounts, 2017 Indiana Code 23-18-11-13 23-18-12-3 FILING FEE: $30.00 APPLICATION FOR CERTIFICATE OF WITHDRAWAL OF: Name of Master Limited Liability Company A FOREIGN MASTER LIMITED LIABILITY COMPANY ADMITTED TO TRANSACT BUSINESS IN THE STATE OF INDIANA The undersigned manager or member of the above, _______________________________________________________________________________ (hereinafter referred to as the "Master LLC"), which exists pursuant to the provisions of _________________________________________________ as (state of country) amended, desiring to effectuate the withdrawal of the Master LLC and all associated Series from the State of Indiana, certifies the following facts: ARTICLE I - NAME Name of Master LLC State or country in which it is organized ARTICLE II - REPRESENTATION BY THE WITHDRAWING MASTER LLC The Master LLC received its Certificate of Authority from the State of Indiana on ______________________________________________________ and is no longer transacting business in Indiana. The Master LLC and all associated Series surrender their authority to transact business in Indiana. Please note that the withdrawal of the Master LLC will cause the withdrawal of every Series associated with it. ARTICLE III - SERVICE OF PROCESS The Master LLC and all associated Series revoke the authority of ___________________________________________________________________, its Registered Agent to accept service of process 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 Indiana. A copy of any such process served on the Secretary of State should be mailed to the following address of the Master LLC: Address of Master LLC (number and street, city, state, and ZIP code) The Master Limited Liability Company shall notify the Secretary of State in the future of any change in its mailing address. In witness whereof, the undersigned being the ___________________________________________________________ of said Master LLC executes (manager or member) this Application for Certificate of Withdrawal and verifies, subject to penalties of perjury, that the statements contained herein are true, this ______ day of ________________________, 20______. Signature Printed name American LegalNet, Inc. www.FormsWorkFlow.com
