Form SS-4254 "Cancellation of Certificate of Authority Following Administrative Revocation (Limited Liability Company)" - Tennessee

What Is Form SS-4254?

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

Form Details:

  • Released on January 1, 2006;
  • The latest edition provided by the Tennessee Secretary 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 printable version of Form SS-4254 by clicking the link below or browse more documents and templates provided by the Tennessee Secretary of State.

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Download Form SS-4254 "Cancellation of Certificate of Authority Following Administrative Revocation (Limited Liability Company)" - Tennessee

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For Office Use Only
CANCELLATION OF CERTIFICATE
OF AUTHORITY FOLLOWING
ADMINISTRATIVE REVOCATION
Corporate Filings
(LIMITED LIABILITY COMPANY)
312 Rosa L. Parks Ave.
6
Floor, William R. Snodgrass Tower
th
Nashville, TN 37243
Pursuant to the provisions of §48-246-505 of the Tennessee Limited Liability Company Act or §48-249-912 of the Tennessee
Revised Limited Liability Company Act, the undersigned Limited Liability Company hereby applies for a Certificate of
Cancellation of Certificate of Authority following administrative revocation from 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 date of revocation
.
month, day, year
3. The state or country under whose law it is formed is: _________________________________________________
4. The Limited Liability Company is not transacting business in the State of Tennessee and surrenders its
authority to transact business in this state.
5. Please mark the applicable statement:
(a) The Limited Liability Company continues its registered office in the State of Tennessee.
(b) 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.
6. The mailing address (including zip code) to which the Secretary of State may mail a copy of any process served on
him is:
7. The undersigned Limited Liability Company makes the commitment to notify the Secretary of State in
the future of any change in its mailing address.
Signature Date
Name of the Limited Liability Company
Signer’s Capacity
Signature
Name (typed or printed)
Filing Fee: $100
SS-4254 (Rev. 01/06)
RDA 2458
For Office Use Only
CANCELLATION OF CERTIFICATE
OF AUTHORITY FOLLOWING
ADMINISTRATIVE REVOCATION
Corporate Filings
(LIMITED LIABILITY COMPANY)
312 Rosa L. Parks Ave.
6
Floor, William R. Snodgrass Tower
th
Nashville, TN 37243
Pursuant to the provisions of §48-246-505 of the Tennessee Limited Liability Company Act or §48-249-912 of the Tennessee
Revised Limited Liability Company Act, the undersigned Limited Liability Company hereby applies for a Certificate of
Cancellation of Certificate of Authority following administrative revocation from 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 date of revocation
.
month, day, year
3. The state or country under whose law it is formed is: _________________________________________________
4. The Limited Liability Company is not transacting business in the State of Tennessee and surrenders its
authority to transact business in this state.
5. Please mark the applicable statement:
(a) The Limited Liability Company continues its registered office in the State of Tennessee.
(b) 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.
6. The mailing address (including zip code) to which the Secretary of State may mail a copy of any process served on
him is:
7. The undersigned Limited Liability Company makes the commitment to notify the Secretary of State in
the future of any change in its mailing address.
Signature Date
Name of the Limited Liability Company
Signer’s Capacity
Signature
Name (typed or printed)
Filing Fee: $100
SS-4254 (Rev. 01/06)
RDA 2458