Wyoming Foreign LLC Certificate of Withdrawal Form

In the case of a foreign limited liability company (LLC) deciding it should withdraw its business operations from the State of Wyoming,  the following form has to be submitted to the Secretary of State’s office.Download

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For Office Use Only  	
 	Wyoming Secretary of State 	
  State Capitol Building, Room 110 
   200 West 24	th Street  
  Cheyenne, W Y 82002-0020 
  Ph.  307. 777.7311  
  Fax 307.777.5339  
  Email:  [email protected]   	
 	
FLLC -Certific ateWithdrawal  – Revised  11/2012 
 	
Foreign  Limited Liability Company  
Application for Certificate of Withdrawal  	
 
Pursuant to W.S. 17-16-1520 of the Wyoming Business Corporation Act, the undersigned limited  liability company 
hereby applies for a Certificate of Withdrawal from the state of Wy oming, and for that purpose submits the following 
statement: 
 
1. N ame of the limited liability company:   
 
 
 
2. O rganized under the laws of:                                                                        \
                                                          	
  (State or country of organization)  	
 
3. It is no longer transacting business in the  state of Wyoming ; and it hereby surrenders its authority to  transact 
business in the state of Wyoming.  
 
4. It 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. Mailing address to which the  Secretary of State may mail a copy of any process served on him under Item 4:  
 
 
 
 
6.  It will notify the Secretary of State in the future of any change in its mailing address.  
 
Date:        Signature : ___________________________________________ 
(mm/dd/yyyy)        (May  be executed by  a member, manager, or other authorized individual as set  
  forth in the operating agreement.)  
 
       Print Name: 
  Title: 
 
Contact Person:      Email: 
 
Daytime Phone Number:  
 
 
 
 
 
 
 
Checklist	 	
          Filing Fee:  $50.00   Make check or money order paya ble to Wyoming Secretary of State. 
          Please submit one original ly signed document  and one exact photocopy of the filing . 
          Please review form prior to submitting to the Secretary of State to ensure all areas have been  
          	completed to	 avoid a delay in the processing of your documents.