Arizona LLC Cancellation Of Name Reservation Form

Should the holder of a reserved business name decide to cancel the reservation, s/he must file this form with Arizona’s SOS’ office and pay for the $__.00 filing fee.Download

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DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY. 	
NOTICE OF CANCELLATION OF APPROVED 
LIMITED LIABILITY COMPANY NAME RESERVATION 	
L003i 
1.  NAME THAT WAS RESERVED  - enter the exact name: 	
_______________________________________________________________________ \
	
2. 
A.C.C. FILE NUMBER:  ___________________________________________________________ 	Find the A.C.C. file number on the upper corner of filed documents OR on\
 our website at: 
http://www.azcc.gov/Divisions/Corporations	
3.   OWNER –
give the name and address of the owner of the reserved name – this is\
 individual or 
entity listed as the Applicant in the Application to Reserve Limited Lia\
bility Company Name or the 
individual or entity to whom the name reservation was transferred (Tran\
sferee) if a Notice of 
Transfer was filed: 	
Name 
Address 1 
Address 2 (optional) 
City 
Country  State or Province 
Zip 	
SIGNATURE: 
By my signature appearing below, I am requesting cancellation of the nam\
e  
reservation listed in the number 1 above. 	
 I ACCEPT 	
Signature                                             Printed Name 
Date (mm/dd/yy)
REQUIRED – 
check only one:	
I am the  Owner (and I am an individual 
or natural person and not an entity). 	   The  Owner is an entity  and I am its duly 
       authorized agent.	
Filing Fee:  $10.00 (regular processing) 
Expedited processing – add $35.00 to filing fee.  
All fees are nonrefundable - see Instructions.       Mail:     Arizona Corporation Commission 
            Corporate Filings Section 
            1300 W. Washington St., Phoenix, Arizona  85007 
Fax:      602-542-4100
Please be advised that A.C.C. forms reflect only the 
minimum provisions required by statute.  You should seek private legal counsel \
for those matters that may pertain 
to the individual needs of your business. 
All documents filed with the Arizona Corporation Commission are  public record and are open for public inspection.  
If you have questions after reading the Instructions, please call 602-54\
2-3026 or (within Arizona only) 800-345-5819.
L003.001                      Arizona Corporation Commission –  Corporations Di\
vision 
Rev: 2010                                                                            \
                                                                        \
              Page 1 of 1        	
Read the Instructions	
By checking the box marked "I accept" below, I acknowledge under penalty 
of perjury  that this document together with any attachments is submitted in 
compliance with Arizona law.