Toll Free: (877) SOS-FILE (877-767-3453)  |  Central Ohio: (614) 466-3910  
                                   www.OhioSecretaryofState.gov  |  Busserv@OhioSecretaryofState.gov 
                                   File online or for more information: www.OHBusinessCentral.com

                                   Filing Form Cover Letter

Please return the approval certificate to:

Name (Individual or Business Name):

To the Attention of (if necessary):

Address:

City:

State                                                                    ZIP Code:

Phone Number:                             E-mail Address:

         Check here if you would like to receive important notices via e-mail from the Ohio Secretary of State's office regarding 
         Business Services.

         Check here if you would like to be signed up for our Filing Notification System for the business entity being created or 
         updated by filing this form. This is a free service provided to notify you via e-mail when any document is filed on your 
         business record.

Please make checks or money orders payable to: "Ohio Secretary of State" 
Type of Service Being Requested:  (PLEASE CHECK ONE BOX BELOW)

Regular Service: Only the filing fee listed on page one of the form is required and the filing will be 
processed in approximately 3-7 business days.  The processing time may vary based on the volume of 
filings received by our office.

Expedite Service 1:  By including an Expedite fee of $100.00, in addition to the regular filing fee on page 
one of the form, the filing will be processed within 2 business days after it is received by our office. 

Expedite Service 2:  By including an Expedite fee of $200.00, in addition to the regular filing fee on page 
one of the form, the filing will be processed within 1 business day after it is received by our office. This 
service is only available to walk-in customers who hand deliver the document to the Client Service Center.

Expedite Service 3:  By including an Expedite fee of $300.00, in addition to the regular filing fee on page 
one of the form, the filing will be processed within 4 hours after it is received by our office, if received by 1:00 
p.m.  This service is only available to walk-in customers who hand deliver the document to the Client Service Center.

Preclearance Filing:  A filing form, to be submitted at a later date for processing, may be submitted to be 
examined for the purpose of advising as to the acceptability of the proposed filing for a fee of $50.00. The 
Preclearance will be complete within 1-2 business days.

Form 562                                  Page 1 of 4                    Last Revised: 10/01/2017

Form 562 Prescribed by:
                                                                                                  Mail this form to one of the following: 
                                   Toll Free: (877) SOS-FILE (877-767-3453) 
                                                                                                     Regular Filing (non expedite) 
                                   Central Ohio: (614) 466-3910                                      P.O. Box 1329 
                                                                                                     Columbus, OH  43216 
                                   www.OhioSecretaryofState.gov 
                                                                                                     Expedite Filing (Two business day processing time. 
                                   Busserv@OhioSecretaryofState.gov                                                            Requires an additional $100.00) 
                                                                                                     P.O. Box 1390 
                                   File online or for more information: www.OHBusinessCentral.com    Columbus, OH  43216
For screen readers, follow instructions located at this path.

         Certificate of Dissolution of Limited Liability Company /  
                   Cancellation of Foreign Limited Liability Company 
                                                             Filing Fee: $50 
                                                             Form Must Be Typed 
(CHECK ONLY ONE (1) BOX)

(1)  Domestic Limited liability Company                                  (2)  Foreign Limited liability Company 
         (For-profit or Nonprofit)                                           (For-profit or Nonprofit) 
         (140-LDS)                                                           (131-LFS)
                                                                            Jurisdiction of Formation

Name of Limited liability Company

If foreign, name of Limited Liability Company in its jurisdiction of formation (if different)

Ohio Registration Number

Complete the information in this section if box (1) is checked.

The Limited Liability Company hereby certifies that the effective date of the of the dissolution is:

                                                             Note: Effective date must be on or before the date of filing.

Complete the information in this section if box (2) is checked.
The undersigned limited liability company hereby certifies that it is no longer transacting business in the state of Ohio.

The limited liability company                                            the authority of its registered agent to accept service of 
                                                                         process, notices and demands on its behalf.
                        (Please enter 'does revoke' or 'does not revoke')
If the authority of the agent is revoked then please provide the address to which a person may mail copy of an process, 
notice, or demand against the company is: 

Mailing Address

City                                                                                         State                             ZIP Code

If this mailing address changes in the future, the limited liability company hereby agrees to notify the Ohio Secretary of State 
of such change.

Form 562                                                     Page 2 of 4                               Last Revised: 10/01/2017

By signing and submitting this form to the Ohio Secretary of State, the undersigned hereby certifies that he or she 
has the requisite authority to execute this document.

Required         
  
Must be signed by an authorized  Signature
representative. 
 
If the authorized representative 
is an individual, then they      By (if applicable)
must sign in the "signature" 
box and print his/her name 
in the "Print Name" box. 
 
                                 Print Name
If the authorized representative 
is a business entity, not an 
individual, then please print 
the entity name in the 
"signature" box, an 
authorized representative        Signature
of the business entity 
must sign in the "By" box 
and print his/her name and 
title/authority in the           By (if applicable)
"Print Name" box. 

                                 Print Name

                                 Signature

                                 By (if applicable)

                                 Print Name

Form 562                                   Page 3 of 4 Last Revised: 10/01/2017

  Instructions for Certificate of Dissolution of Limited Liability Company/Cancellation of Foreign 
                                       Limited Liability Company

This form should be used to file a Certificate of Dissolution of a Domestic Limited Liability Company 
pursuant to Ohio Revised Code §1705.43 or to file a Cancellation of a Foreign Limited Liability Company 
pursuant to Ohio Revised Code §1705.57.  Please select the appropriate box to indicate whether the 
entity is a domestic or foreign limited liability company.  If foreign, please provide the jurisdiction of 
formation in the space provided. 
  
Limited Liability Company Information 
The dissolution/cancellation must set forth the name of the company and the Ohio registration number.  If 
the company is a foreign company, then provide the name under which the company is registered in this 
state and, if different, the name under which it is registered or organized in its jurisdiction of formation. 
  
Domestic Limited Liability Company Effective Date 
A domestic limited liability company must provide the effective date of the dissolution pursuant to Ohio 
Revised Code §1705.43(B).  The effective date must be the date of filing or a prior date.  Future effective 
dates are not permissible under ORC §1705.43(B). 
  
Foreign Limited Liability Company 
By signing this form the foreign entity agrees to the statement on the form which states that the company 
is not transacting business in Ohio.   
  
Pursuant to Ohio Revised Code §1705.57(C), please complete the blank in the second statement to 
indicate whether the authority of its statutory agent in Ohio to accept service of process, notices, and 
demands is revoked or not revoked.  If it is revoked, provide an address to which a person may mail a 
copy of any process, notice, or demand against the company.  Furthermore, by signing this form the 
foreign entity agrees to the final statement which states that the company agrees to notify our office in the 
future of any change in the mailing address provided. 
  
Signature(s) 
After completing all information on the filing form, please make sure that page 2 is signed by at least one 
authorized representative of the limited liability company.  

Form 562                               Page 4 of 4              Last Revised: 10/01/2017