COVER LETTER
TO: Registration Section
Division of Corporations
SUBJECT:
Name of Limited Liability Company
Dear Sir or Madam:
The enclosed Statement of Denial and fee(s) are submitted for filing.
Please return all correspondence concerning this matter to the following:
Name of Person
Firm/Company
Address
City/State and Zip Code
E-mail address: (to be used for future annual report notification)
For further information concerning this matter, please call:
at ( )
Name of Person Area Code Daytime Telephone Number
Mailing Address: Street Address:
Registration Section Registration Section
Division of Corporations Division of Corporations
P.O. Box 6327 The Centre of Tallahassee
Tallahassee, FL 32314 2415 N. Monroe Street, Suite 810
Tallahassee, FL 32303
CR2E139 (2/14)
STATEMENT OF DENIAL
Pursuant to section 605.0303, Florida Statutes, I hereby submit the following statement of denial:
FIRST: The name of the limited liability company is:
SECOND: The document number of this limited liability company is:
THIRD: The statement of authority to which this statement of denial pertains is:
and this grant of authority is denied.
Signature of person submitting denial Typed or printed name of signature
Filing Fee: $25.00
Certified Copy: $30.00 (optional)
CR2E139 (2/14)