Form DSCB:15-8872(F) "' certificate of Termination - Domestic Limited Liability Company" - Pennsylvania

What Is Form DSCB:15-8872(F)?

This is a legal form that was released by the Pennsylvania Department of State - a government authority operating within Pennsylvania. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2017;
  • The latest edition provided by the Pennsylvania Department of State;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DSCB:15-8872(F) by clicking the link below or browse more documents and templates provided by the Pennsylvania Department of State.

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Download Form DSCB:15-8872(F) "' certificate of Termination - Domestic Limited Liability Company" - Pennsylvania

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PENNSYLVANIA DEPARTMENT OF STATE
BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS
Return document by mail to:
Name
Address
City
State
Zip Code
Return document by email to:
_________________________________
Read all instructions prior to completing. This form may be submitted online at https://www.corporations.pa.gov/.
Fee: $70
In compliance with the requirements of the applicable provisions of 15 Pa.C.S.
§ 8872(f)
(relating to certificate of
termination), the undersigned limited liability company, desiring to terminate, hereby states that:
1. The name of the limited liability company is: ___________________________________________________________
2. The current registered office address as on file with the Department of State. Complete part (a) OR (b) – not both:
(a) _________________________________________________________________________________________________
Number and street
City
State
Zip
County
(b) c/o: ______________________________________________________________________________________________
Name of Commercial Registered Office Provider
County
3. Check one of the following:
All debts, obligations and other liabilities of the limited liability company have been paid and discharged.
Adequate provision has been made for the payment and discharge of the debts, obligations and other liabilities of
the limited liability company.
4. All the remaining property and assets of the limited liability company have been distributed among its members in
accordance with their respective rights and interests.
5. Check one of the following:
There are no actions pending against the limited liability company in any court.
Adequate provision has been made for the satisfaction of any judgment that may be entered against the limited
liability company in any pending action.
6. The limited liability company is terminated.
IN TESTIMONY WHEREOF, the undersigned limited liability company has caused this Certificate of Termination to be
signed by a duly authorized representative thereof this ___________ day of _________________________, 20_____ __ .
___________________________________________________
Name of Limited Liability Company
___________________________________________________
Signature
___________________________________________________
Title
PENNSYLVANIA DEPARTMENT OF STATE
BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS
Return document by mail to:
Name
Address
City
State
Zip Code
Return document by email to:
_________________________________
Read all instructions prior to completing. This form may be submitted online at https://www.corporations.pa.gov/.
Fee: $70
In compliance with the requirements of the applicable provisions of 15 Pa.C.S.
§ 8872(f)
(relating to certificate of
termination), the undersigned limited liability company, desiring to terminate, hereby states that:
1. The name of the limited liability company is: ___________________________________________________________
2. The current registered office address as on file with the Department of State. Complete part (a) OR (b) – not both:
(a) _________________________________________________________________________________________________
Number and street
City
State
Zip
County
(b) c/o: ______________________________________________________________________________________________
Name of Commercial Registered Office Provider
County
3. Check one of the following:
All debts, obligations and other liabilities of the limited liability company have been paid and discharged.
Adequate provision has been made for the payment and discharge of the debts, obligations and other liabilities of
the limited liability company.
4. All the remaining property and assets of the limited liability company have been distributed among its members in
accordance with their respective rights and interests.
5. Check one of the following:
There are no actions pending against the limited liability company in any court.
Adequate provision has been made for the satisfaction of any judgment that may be entered against the limited
liability company in any pending action.
6. The limited liability company is terminated.
IN TESTIMONY WHEREOF, the undersigned limited liability company has caused this Certificate of Termination to be
signed by a duly authorized representative thereof this ___________ day of _________________________, 20_____ __ .
___________________________________________________
Name of Limited Liability Company
___________________________________________________
Signature
___________________________________________________
Title
DSCB:15-8872(f)–Instructions
Pennsylvania Department of State
Bureau of Corporations and Charitable Organizations
P.O. Box 8722
Harrisburg, PA 17105-8722
(717) 787-1057
Website:
www.dos.pa.gov/corps
certificates, a Form REV-181 (Application for Tax Clearance
General Information
Certificate) must be completed and submitted to both the
Typewritten is preferred. If handwritten, the form must be
Department of Revenue and the Department of Labor and
legible and completed in black or blue-black ink in order to
Industry. The application and instructions may be downloaded
permit reproduction.
from the Department of Revenue website at
www.revenue.pa.gov
or obtained by calling 717-783-6052.
The nonrefundable filing fee for this form is $70. Checks
should be made payable to the Department of State. Checks
must contain a commercially pre-printed name and address.
Form Instructions
This form and all accompanying documents shall be mailed to
Enter the name and mailing address to which any
the address stated above.
correspondence regarding this filing should be sent. This field
must be completed for the Bureau to return the filing. If the
Who should file this form?
filing is to be returned by email, an email address must be
When all debts, obligations and other liabilities of the limited
provided. An email will be sent to address provided,
liability company have been paid and discharged or adequate
containing a link and instructions on how a copy of the filed
provision has been made therefor and all of the remaining
document or correspondence may be downloaded. Any email
property and assets of the company have been distributed to
or mailing addresses provided on this form will become part
the members, a domestic limited liability company shall
of the filed document and therefore public record.
execute a Certificate of Termination and deliver it to the
Department of State for filing, along with the certificates
1. Give the exact name of the limited liability company as on
required by 15 Pa.C.S. § 139 (relating to tax clearance of
file with the Department of State. This field is required.
certain fundamental transactions).
2. Current address. The address provided must be the limited
A Certificate of Termination will serve to remove the limited
liability company’s registered office address (a) or
liability company from the rolls of active associations in the
Commercial Registered Office Provider (b) as on file with the
records of the Department. Upon the filing of a Certificate of
Department of State at the time the Certificate of Termination
Termination, the existence of the limited liability company
is submitted for filing. This field is required.
shall cease, except for the purpose of legal actions, other
proceedings and appropriate action as provided by law.
3. Check only one of the boxes, based on the status or
situation of the terminating company. This field is required.
Applicable Law
For dissolution, winding up and termination of limited liability
4. Mandatory statement. This field is required.
companies, in general, see 15 Pa.C.S. §§ 8871-8878. Statutes
are available on the Pennsylvania General Assembly website,
5. Check only one of the boxes, based on the status or
www.legis.state.pa.us, by following the link for Statutes.
situation of the terminating company. This field is required.
Attachments
6. Mandatory statement. This field is required.
The following, in addition to the filing fee, shall accompany
this form:
Signature and Verification
(1) Tax clearance certificates from the Department of
An authorized representative of the limited liability company
Revenue and the Department of Labor and Industry
must sign the Certificate of Termination. Signing a document
evidencing payment of all taxes and charges payable to
delivered to the Department for filing is an affirmation under
the Commonwealth as described in the following
the penalties provided in 18 Pa.C.S. § 4904 (relating to
paragraph.
unsworn falsification to authorities) that the facts stated in the
(2) Any necessary governmental approvals.
document are true in all material respects.
This field is required.
Tax clearance certificates:
A domestic limited liability company may not file a Certificate
of Termination unless the document is accompanied by tax
clearance certificates from the Department of Revenue and the
Department of Labor and Industry evidencing the payment by
the association of all taxes and charges due the
Commonwealth required by law. To obtain these clearance
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