FLORIDA DEPARTMENT OF STATE  
                             DIVISION OF CORPORATIONS 
 
Attached are the form and instructions to withdraw and cancel the certificate of authority of a 
foreign limited liability company. The requirements are as follows: 
 
 Pursuant to s. 605.0910, Florida Statutes, the attached withdrawal application must be  
  completed in its entirety. 
 
 The fees are as follows: 
 
               $25.00   Filing Fee 
               $30.00   Certified Copy (optional) 
               $  5.00   Certificate of Status (optional) 
 
 A letter of acknowledgment will be issued free of charge upon withdrawal.   
  Submit one check made payable to the Florida Department of State for the 
  total amount of the filing fee and any optional certificate or copy. 
 
 A COVER letter should be submitted along with the application and check. The 
  mailing address and courier address are noted below. 
 
 Please send the application to: 
 
  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 
 
Any further inquiries concerning this matter should be directed to the Registration Section by 
calling (850) 245-6051. 
 
CR2E057 (6/17) 
 

                                             COVER LETTER 
                                                         
TO: Registration Section 
    Division of Corporations 
 
SUBJECT:                                                                                                            
                             (Name of Foreign Limited Liability Company)         
                                                         
Dear Sir or Madam: 
 
The enclosed withdrawal and fee(s) are submitted for filing. 
 
Please return all correspondence concerning this matter to the following: 
 
                            (Name of Person) 
 
                            (Firm/Company)   
 
                            (Address) 
 
                            (City/State and Zip Code) 
 
For further information concerning this matter, please call: 
 
                                                         at (  )                                                    
           (Name of Person)                                     (Area Code & Daytime Telephone Number) 
 
    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 
                                  
Enclosed is a check for the following amount: 
 
 ☐$25 Filing Fee        ☐ $30 Filing Fee &            ☐$55 Filing Fee &       ☐ $60 Filing Fee,  
                            Certificate of Status            Certified Copy               Certificate of Status &  
                                                                         Certified Copy 
 

 NOTICE OF WITHDRAWAL OF CERTIFICATE OF AUTHORITY 
                                                    
                                 (Name of limited liability company) 
 
                                 (Jurisdiction of its organization) 
                                                    
                           (Date registered with Florida Department of State) 
                                                    
                                 (Florida Document Number) 
                                                    
This limited liability company is withdrawing its certificate of authority in this state. 
 
Effective Date, if other than the date of filing:                               (optional) 
(If an effective date is listed, the date must be specific and cannot be prior to date of filing or 
more than 90 days after filing.) 
Note: If the date inserted in this block does not meet the applicable statutory filing requirements, 
this date will not be listed as the document’s effective date on the Department of State’s records.  
 
                            (Signature of authorized representative) 
 
                                 (Typed or printed name of signee) 
 
                                  Filing Fee:  $25.00