Delaware Division of Corporations 
                                  401 Federal Street – Suite 4 
                                      Dover, DE  19901 
                                      Ph: 302-739-3073 
                                      Fax: 302-739-3812 
                                                  
                                                                 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-
 3073. 
  
                                                         S in c e r e ly , 
  
                                                         D e p a r tm e n t o f  S ta te  
         Division of Corporations 
  
 encl. 
 rev. 6/04 

       STATE OF DELAWARE 
     CERTIFICATE OF CANCELLATION 
 
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.________. 
 
                           By:____________________________________ 
            Authorized Person(s) 
 
         Name:__________________________________ 
            Print or Type