Application For Cancellation Of Certificate Of Authority (Tennessee)
This is an application for cancellation of certificate of authority of a limited liability company in Tennessee. The form provided here is simply a sample of what the actual Form SS 4241 looks like.
For Office Use Only
APPLICATION FOR CANCELLATION
OF CERTIFICATE OF AUTHORITY
(LIMITED LIABILITY COMPANY)
Corporate Filings
312 Eighth Avenue North
6th Floor, William R. Snodgrass Tower
Nashville, TN 37243
To the Secretary of State of the State of Tennessee:
Pursuant to the provisions of ยง48-246-401 of the Tennessee Limited Liability Company Act, the undersigned Limited Liability Company hereby applies for a certificate of cancellation form the State of Tennessee, and for that purpose sets forth:
1. The name of the Limited Liability Company is
___________________________
If different, the name under which the certificate of authority was obtained is
___________________________
2. The state or country under whose law it is organized is
___________________________
3. The Limited Liability Company is not transacting business in the State of Tennessee and surrenders its authority to transact business in this state.
4. Indicate which of the following statements apply by marking the applicable box:
___ The Limited Liability Company continues its registered agent and registered office in the State of Tennessee.
___ The Limited Liability Company hereby revokes the authority of its registered agent to accept service on its behalf and appoints the Secretary of State as its agent for service of process in any proceeding based on a cause of action arising during the time it was authorized to transact business in this state.
5. The mailing address (including zip code) to which the Secretary of State may mail a copy of any process served on him is
Street ___________________________
City ___________________________
State ___________________________
Zip Code ___________________________
6. The undersigned Limited Liability Company makes the commitment to notify the Secretary of State in the future of any change in its mailing address.
Street ___________________________
City ___________________________
State ___________________________
Zip Code ___________________________
Signature Date ___________________________
Name of Limited Liability Company ___________________________
Signer's Capacity Signature ___________________________
Name ___________________________ (typed or printed)