THE  TATE S
                                                                                                                                                  COR 
                                  of                                                                                             FOR DIVISION USE ONLY 

                                       ALASKA 
  
                                 Department of Commerce, Community, and Economic Development 
                                 Division of Corporations, Business and Professional Licensing 
                                   
                                  Corporations Section 
                                  State Office Building, 333 Willoughby Avenue, 9th Floor  
                                  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          •    “Withdrawn”      status.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: 
                www.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. 
          •    The information you submit is a public record and will be posted online at www.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 
                                                                                                                                                         
                                           Non-Refundable Filing Fee                                                                             $25.00 
                 Fee:                   Mail this form and the non-refundable $25 filing fee in U.S. dollars to the letterhead address. Make the   
                                    
                                        check or money order payable to the State of Alaska, or use the attached credit card payment form.         
                                                                                                                                                          
       PART II         Entity Information                                                                                           
                                                                                                                                                   AS 10.50.660      

     Entity Name:                       

                                                                                             State or Country 
     Alaska Entity Number:                                                                                                        
                                                                                              of Domicile: 
  
     PART III  Attestations                                                                                      AS 10.50.660,AS                 10.50.660(2)-(4) 
     By submitting     this form, I am confirming: 
               
            This 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 www.Corporations.Alaska.Gov, click Search Corporations Database. 
      
 08-502            (Rev. 10/10/2020)          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 company. 
     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: 

  Physical Address:  

  Mailing Address:  

  PART V       Required Signature                                                                                 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. 

  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.                                             

Remember    to notify other sections of this division when appropriate: 
BUSINESS LICENSING SECTION:  
Submit Business License: Request to Cancel (form 08-4732) to cancel any business licenses associated with this entity.  Go to 
www.BusinessLicense.Alaska.Gov for more information and forms. 
 
PROFESSIONAL LICENSING SECTION:       
Email License@Alaska.Gov for more information and appropriate forms. 
 
08-502        (Rev. 10/10/2020)          F-LLC Certificate of Cancellation Page 2 of 2 
   

                  THE  TATE S                                                                                                                                   COR 
                     of                                                          FOR DIVISION USE ONLY 
                       ALASKA                                                                                                                 
                  Department of Commerce, Community and Economic Development 
                  Division of Corporations, Business and Professional Licensing 
 
         Corporations     Section  
                                                             th
         State Office Building, 333 Willoughby Avenue, 9  Floor 
 
         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 

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

        Entity Name:                    

        AK Entity #:                    
                                                                                                                                                                 
       Contact Person                              Whom may we contact with any questions or problems with this filing? 

        Company:                        

        Contact:                        

                                 Address: 
        Mailing Address: 
                                 City:                                                                         State:                   ZIP: 

        Phone:                      

        Email:                          
      
       Document Return Address                               Provide an address for the return of your filed documents. 
      
           Return my filings to the address provided ABOVE                       
           Return my filings to this address provided BELOW                      
      
        Company:                  

        Contact:                  

                                 Address: 
        Mailing Address: 
                                 City:                                                                         State:                   ZIP: 
 
  08-561           Rev 7/14/16           Contact Information 

              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! 

                                                                                                                           All  3fields            MUST 
   1. Credit Card Number:                                                                                                           be completed! 

   2. Expiration Date:                                                                                        This section will be 

      Security Code:                                                                                          destroyed after the 
   3.
                                                                                                              payment is processed.