Form BUS-042 "Statement of Withdrawal of Registration - Foreign Limited Liability Company" - Connecticut

What Is Form BUS-042?

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

Form Details:

  • Released on October 1, 2020;
  • The latest edition provided by the Connecticut Secretary of the 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 BUS-042 by clicking the link below or browse more documents and templates provided by the Connecticut Secretary of the State.

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Download Form BUS-042 "Statement of Withdrawal of Registration - Foreign Limited Liability Company" - Connecticut

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Secretary of the
State of Connecticut
OFFICE USE ONLY
(label)
860-509-6003
crd@ct.gov
www.concord-sots.ct.gov
PHONE:
EMAIL:
WEB
:
STATEMENT OF WITHDRAWAL
•Use ink.
•Print or type.
OF REGISTRATION
•Attach additional 8 1/2 x 11 sheets if necessary
FOREIGN LIMITED LIABILITY COMPANY
FILING PARTY
(confirmation will be sent to this address):
NAME:
FILING FEE: $120.00
MAILING
ADDRESS:
Make checks payable to
"Secretary of the State"
CITY:
STATE:
ZIP:
1. NAME OF LIMITED LIABILITY COMPANY IN STATE OR COUNTRY OF FORMATION
(required) (name must exactly
match the name on our records, including the business designation, e.g. LLC,L.L.C., etc.)
2. NAME UNDER WHICH THE LIMITED LIABILITY COMPANY TRANSACTS BUSINESS IN CONNECTICUT
(if applicable) (name must exactly match the name on our records, including the business designation, e.g. LLC,L.L.C., etc.)
3. STATE OR COUNTRY OF FORMATION
(required):
4. ADDRESS TO MAIL PROCESS SERVED UPON THE SECRETARY OF THE STATE PURSUANT TO THE
APPOINTMENT MADE ABOVE
(Must be a street address. A P.O. Box is acceptable as additional information only)
MAILING
ADDRESS:
CITY:
STATE:
ZIP:
5. SURRENDER OF CERTIFICATE AND APPOINTMENT OF AGENT.
The undersigned asserts that the above-named limited liability company is not transacting business in Connecticut and
surrenders its certificate of registration to do so. It further revokes the authority of its registered agent and consents that
process in any action, suit or proceeding based upon any cause of action arising in Connecticut during the time the
limited liability company was authorized to transact business in this state may be served upon the secretary of the state.
6. EXECUTION / SIGNATURE OF AUTHORIZED OFFICIAL OF THE LIMITED LIABILITY COMPANY
(required)
(submitted under penalty of false statement):
DATE SIGNED
/
/
(mm/dd/yyyy):
CAPACITY/TITLE OF SIGNATORY
NAME OF SIGNATORY
SIGNATURE
( ( print or type)
(print or type)
PAGE 1 OF 1
BUS-042 (FOREIGN LLC, WITHDRAWAL OF REGISTRATION)
REV. 10/2020
Secretary of the
State of Connecticut
OFFICE USE ONLY
(label)
860-509-6003
crd@ct.gov
www.concord-sots.ct.gov
PHONE:
EMAIL:
WEB
:
STATEMENT OF WITHDRAWAL
•Use ink.
•Print or type.
OF REGISTRATION
•Attach additional 8 1/2 x 11 sheets if necessary
FOREIGN LIMITED LIABILITY COMPANY
FILING PARTY
(confirmation will be sent to this address):
NAME:
FILING FEE: $120.00
MAILING
ADDRESS:
Make checks payable to
"Secretary of the State"
CITY:
STATE:
ZIP:
1. NAME OF LIMITED LIABILITY COMPANY IN STATE OR COUNTRY OF FORMATION
(required) (name must exactly
match the name on our records, including the business designation, e.g. LLC,L.L.C., etc.)
2. NAME UNDER WHICH THE LIMITED LIABILITY COMPANY TRANSACTS BUSINESS IN CONNECTICUT
(if applicable) (name must exactly match the name on our records, including the business designation, e.g. LLC,L.L.C., etc.)
3. STATE OR COUNTRY OF FORMATION
(required):
4. ADDRESS TO MAIL PROCESS SERVED UPON THE SECRETARY OF THE STATE PURSUANT TO THE
APPOINTMENT MADE ABOVE
(Must be a street address. A P.O. Box is acceptable as additional information only)
MAILING
ADDRESS:
CITY:
STATE:
ZIP:
5. SURRENDER OF CERTIFICATE AND APPOINTMENT OF AGENT.
The undersigned asserts that the above-named limited liability company is not transacting business in Connecticut and
surrenders its certificate of registration to do so. It further revokes the authority of its registered agent and consents that
process in any action, suit or proceeding based upon any cause of action arising in Connecticut during the time the
limited liability company was authorized to transact business in this state may be served upon the secretary of the state.
6. EXECUTION / SIGNATURE OF AUTHORIZED OFFICIAL OF THE LIMITED LIABILITY COMPANY
(required)
(submitted under penalty of false statement):
DATE SIGNED
/
/
(mm/dd/yyyy):
CAPACITY/TITLE OF SIGNATORY
NAME OF SIGNATORY
SIGNATURE
( ( print or type)
(print or type)
PAGE 1 OF 1
BUS-042 (FOREIGN LLC, WITHDRAWAL OF REGISTRATION)
REV. 10/2020
STATEMENT OF WITHDRAWAL OF REGISTRATION
FOREIGN LIMITED LIABILITY COMPANY
A foreign limited liability company authorized to transact business in Connecticut may withdraw its certificate of registration
by filing a statement of withdrawal of registration.
INSTRUCTIONS
Numbers below correspond to numbered sections of the form.
1. NAME OF LIMITED LIABILITY COMPANY IN STATE OR COUNTRY OF FORMATION. Provide the name of the limited
liability company exactly as it appears on our records, including the business designation, (e.g., LLC, L.L.C., etc.)
2. NAME UNDER WHICH LIMITED LIABILITY COMPANY TRANSACTS BUSINESS IN CONNECTICUT.
Provide the name under which the limited liability company transacts business in Connecticut, if the name is different from
the name shown in Section 1 above. The name provided must exactly match the name as it currently appears on our
records, including the business designation, (e.g., LLC, L.L.C., etc.)
3. STATE / COUNTRY OF FORMATION. Provide the limited liability company’s state or country of formation.
4. MAILING ADDRESS FOR PROCESS SERVED UPON THE SECRETARY OF THE STATE.
a.
The limited liability company is required by law to appoint the Secretary of the State of Connecticut as its agent to
receive legal process in any action suit or proceeding which is based upon a cause of action arising in Connecticut
during the time it was authorized to transact business.
b.
Provide an address to which the Secretary of the State must mail a copy of any process received pursuant to this
appointment. The address must include, at minimum, a street, city, state (or country if outside of the United States)
and a postal code.
5. EXECUTION/SIGNATURE:
a.
The document must be executed/signed by an authorized official of the limited liability company. That person
must print or type their name, state the capacity/title under which they sign, and provide a signature.
b.
The execution/signature constitutes a legal statement submitted under penalty of false statement that the information
provided in the document is true.
OFFICE OF THE SECRETARY OF THE STATE
MAILING ADDRESS
BUSINESS SERVICES DIVISION
CONNECTICUT SECRETARY OF THE STATE
P.O. BOX 150470
HARTFORD, CT 06115- 0470
DELIVERY ADDRESS
BUSINESS SERVICES DIVISION
CONNECTICUT SECRETARY OF THE STATE
165 CAPITOL AVE, SUITE 1000
HARTFORD, CT 06115-0470
PHONE: 860-509-6003
WEBSITE:
www.concord-sots.ct.gov
INSTRUCTIONS
BUS-042 (FOREIGN LLC, WITHDRAWAL OF REGISTRATION)
REV. 8/2020
Page of 2