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                                        STATE OF SOUTH CAROLINA 
                                            SECRETARY OF STATE 

                                FOREIGN LIMITED LIABILITY COMPANY 
                                        CERTIFICATE OF CANCELLATION 
                                OF AUTHORITY TO TRANSACT BUSINESS IN 
                                            SOUTH CAROLINA 

This foreign limited liability company in accordance with Section 33-44-1007 of the 1976 S.C. Code of Laws, as
amended, hereby cancels its authority to transact business in South Carolina by filing this certificate of cancellation. 
1. The name of the foreign limited liability company as filed in South Carolina is:

2.The foreign limited liability company was qualified in South Carolina on __________.
3. The foreign limited liability company is no longer transacting business in South Carolina.
4. The foreign limited liability company cancels its authority to transact business in South Carolina.

5.The forwarding address to which the Secretary of State may mail a copy of any process served on the limited
liability company is:

_____________________________________________________________________________________________ 
(Street Address) 

_____________________________________________________________________________________________ 
 (City, State, Zip Code) 

Date __________ 

_____________________________________________________________________________________________ 
 (Signature) 

_____________________________________________________________________________________________ 
   (Print Name)

_____________________________________________________________________________________________ 
 (Capacity) 

                                                         Form Revised by South Carolina Secretary of State, August 2016 
                                                                                                              F0054 



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                                 FILING INSTRUCTONS 
                                        
1. File two copies of this application, the original and either a duplicate original or a conformed copy. Include a 
   self-addressed stamped envelope to have a filed copy returned to you by mail. 
2. If management of this foreign limited liability company is vested in managers, a manager shall execute this 
   certificate of cancellation of authority to transact business in South Carolina.  Specify in which capacity the 
   person is signing. 
3. If space on this form is insufficient, please attach additional sheets containing a reference to the appropriate 
   paragraph in this form.  
4. This application must be accompanied by the filing fee of $10.00, payable to the Secretary of State. 
   Return to: Secretary of State 
              Attn:  Corporate Filings 
              1205 Pendleton Street, Suite 525 
              Columbia, SC 29201 

                                       Form Revised by South Carolina Secretary of State, August 2016 
                                                                                                        F0054 
 






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