THE  TATES                                                                                           COR 
               of                                                                           FOR DIVISION USE ONLY 
                ALASKA 
               Department of Commerce, Community, and Economic Development 
               Division of Corporations, Business and Professional Licensing 

  Corporations Section 
  PO Box 110806, Juneau, AK 99811-0806 
  Phone: (907) 465-2550 • Fax: (907) 465-2974 
  Email: Corporations@Alaska.Gov  
  Website: Corporations.Alaska.Gov          

Certificate of Cancellation 

Foreign Limited Liability Company                                                                                   AS 10.50 
 This Certificate of Cancellation is only for a Foreign Limited Liability Company. Once filed, the entity will be placed into a
  “Withdrawn” status.
 This form will not be filed if the official signing this form does not match an official on record for this entity, and/or if your
  entity’s biennial report is not current. Verify your entity’s status and current information online at: Corporations.Alaska.Gov,
  click Search Corporations Database.
 Standard processing time for complete and correct filings submitted to this office is approximately 10-15 business days (2-3
  weeks). All filings are reviewed in the date order they are received.
 Make checks and money orders payable to the State of Alaska or use the attached credit card payment form.
 The information you submit is a public record and will be posted online at Corporations.Alaska.Gov
Important: A foreign limited liability company registered in this state may cancel its registration by filing an application for cancellation 
with the department. – AS 10.50.655 

PART I         Payment of Fees                                                                                      3 AAC 16.065

Required Fee:             Nonrefundable Filing Fee                                                                   $25.00 

PART II        Entity Information                                                                                   AS 10.50.660

Entity Name:  

Alaska Entity                                                           State or Country 
Number:                                                                 of Domicile: 

PART III  Attestations                                                                    AS 10.50.660, AS 10.50.660(2)-(4) 
By submitting this form, I am confirming:  
  The entity is in good standing.   
  All biennial reports due have been filed and paid.       
  The Company is not transacting business in Alaska.        
  The Company surrenders its authority to transact business in Alaska. 
  The Limited Liability Company revokes the authority of the registered agent in Alaska and consents that service of process 
  may subsequently be made on the Limited Liability Company by service on the Commissioner. 
To verify the entity’s status and reports, go to Corporations.Alaska.Gov and click on Search Corporations Database. 

08-502 (Rev. 11/0 /2021)8                         F-LLC Certificate of Cancellation                                   Page 1 of 2 

PART IV       Service of Process                                                                                      AS 10.50.660(5)
Provide the name and address where the Commissioner may mail any service of process against the Corporation. 
Per Part III, the authority of the registered agent in Alaska is revoked. Do not list the registered agent in Alaska. 
                                                        Entity or Individual 
Full Legal Name:  
                         Street                            City                          State                          Zip 
Physical Address:   
                    P.O. Box or Street                     City                        State                            Zip 
Mailing Address:  

PART V        Signatures                                                                         AS 10.50.665, 10.06.825

The Certificate of Cancellation must be signed by a person with authority to sign the application under the law of the state 
or other jurisdiction of its organization. If the person signing is not an official on record with this LLC, then state the person’s 
signing authority below.
Per AS 10.06.825, persons who sign documents filed with the Commissioner which are known to the person to be false in 
material respects are guilty of a class A misdemeanor. 

Printed Name:                                                                        Title: 

Signature:                                                                           Date:  

If signing on behalf of a Member or Manager that is another entity or a trust, then you must identify the signer’s relationship and 
signing authority on behalf of the entity or trust. For example: John Smith, President of XYZ Inc., the sole member of ABC LLC; or, 
John Smith, Trustee of ABC Revocable Trust.        

IMPORTANT: Remember to notify other sections of this division when appropriate: 
 Business Licensing Section: BusinessLicense.Alaska.Gov
  Submit Business License: Request to Cancel form (#08-4732) to cancel any business licenses associated with this entity.
 Professional Licensing Section:        ProfessionalLicense.Alaska.Gov
  Email License@Alaska.Gov for more information and appropriate forms.

08-502 (Rev. 11/08/2021)                           F-LLC Certificate of Cancellation                                    Page 2 of 2 

                  THE  TATES                                                                         COR 
                  of                                                                           FOR DIVISION USE ONLY 
                   ALASKA 
                  Department of Commerce, Community, and Economic Development 
                  Division of Corporations, Business and Professional Licensing 

  Corporations Section 
  PO Box 110806, Juneau, AK 99811-0806 
  Phone: (907) 465-2550 • Fax: (907) 465-2974 
  Email: Corporations@Alaska.Gov  
  Website: Corporations.Alaska.Gov       

Contact Information  

 Return this form with your filing.
 This information may be used by the Division to assist with processing your attached filings.
 This form will not be filed for record or appear online.

PART I          Entity Information 
Enter your entity information as it appears on this filing. 

Entity Name:  

Alaska Entity 
Number: 

PART II       Contact Information 
Whom may we contact with any questions or problems with this filing?  

Company:   

Contact Person:  
                   P.O. Box or Street                          City                    State     Zip 
Mailing Address:  

Phone Number:                                                        Email Address:  

PART III      Document Return Address 
  Return my filings to the address provided ABOVE. 

  Return my filings to the address provided BELOW: 

Company: 

Contact Person: 
                   P.O. Box or Street                          City                    State     Zip 
Mailing Address:  

08-561 (Rev. 11/08/2021)                                      Contact Information                Page 1 of 1 

              THE  TATE S                                                                                                  FOR DIVISION USE ONLY 
                of 
                  ALASKA 
              Department of Commerce, Community, and Economic Development 
              Division of Corporations, Business and Professional Licensing 

        State of Alaska 
        Department of Commerce, Community, and Economic Development 
        Division of Corporations, Business and Professional Licensing 
        PO Box 110806, Juneau, AK 99811 
        Phone: (907) 465-2550 

Credit Card Payment Form 

All major credit cards are accepted. For security purposes, do not email credit card information. 
Include this credit card payment form with your application.  

Name of Applicant or Licensee:      _________________________________________________________________________________________________________________________ 

Program Type:   ________________________________________________________       License Number (if applicable):                      ________________________________ 

 I wish to make payment by credit card for the following(check all that apply):                                                                    AMOUNT    

        Application Fee:  _________________________________________________________________________________________________                __________________________ 

        License or Renewal Fee:     _________________________________________________________________________________                      __________________________ 

        Other (name change, wall certificate, fine, duplicate license, exam, etc.):        

           1. _____________________________________________________________________________________________________________________ __________________________ 

           2. _____________________________________________________________________________________________________________________        __________________________

                                                                                               TOTAL:            ___________________________ 

Name (as shown on credit card):   ________________________________________________________________________________________________________________________ 

Mailing Address:            ___________________________________________________________________________________________________________________________________________________ 

Phone Number:   ________________________________________________________      Email (optional):               _______________________________________________________ 

Signature of Credit Card Holder:              _____________________________________________________________________________________________________________________ 

 08-4438                   Rev 12/26/18                   Credit Card Payment Form (all major cards accepted) 

   CREDIT CARD INFO:  Your payment cannot be processed unless all fields are completed! 

   1.    Account Number:                                                                                      All four fields MUST 
                                                                                                                                    be completed! 
   2.    Expiration Date:
                                                                                                              This section will be 
   3.    Billing ZIP Code:
                                                                                                              destroyed after the 
   4.    Security Code:                                                                                       payment is processed.