This form contains 22 fields organized into 10 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Article I - LLC Name
Article I — LLC Name Text
Enter the full legal name of the limited liability company exactly as it appears on the company’s formation documents or state records.
Max length: 73 characters
Article II - SCC ID Number
Article II — LLC SCC ID Number Number
Enter the limited liability company’s SCC (State Corporation Commission) identification number assigned by the Virginia State Corporation Commission.
Max length: 53 characters
Article III - Certificate Effective Date
Article III — Certificate Effective Date Date
Enter the date on which the Commission issued the LLC’s certificate of organization.
Max length: 16 characters
Article V - Additional Information (optional)
Article V - Additional Information, Line 1 Text
Enter the first line of any optional additional information the members choose to include about the LLC, such as clarifying details, notes, or short statements.
Max length: 73 characters
Article V - Additional Information, Line 2 Text
Enter the second line of any optional additional information the members choose to include about the LLC, continuing or expanding on the information entered on Line 1.
Max length: 78 characters
Correspondence Name and Mailing Address
Correspondence Contact Name Text
Enter the full name of the person or organization to receive correspondence about this filing.
Max length: 86 characters
Correspondence Mailing Address Text
Enter the complete mailing address where correspondence should be sent, including street, city, state/province and ZIP/postal code.
Max length: 86 characters
File Online Today
File Online Today (1) Text
Enter whether you will file these articles online through the Virginia SCC CIS site (for example, 'Yes', 'No', or other short note about online filing).
Max length: 29 characters
Online Payment Amount (2) Number
Enter the dollar amount you are paying online for filing (enter only the numeric value of the payment). Fill only if 'File Online Today (1)' is 'Yes'.
Max length: 6 characters
Depends on: File Online Today (1)
Filing Requirements Header
Filing Requirements Reference Text
Enter the reference number or short identifier shown for the Filing Requirements header that links these instructions to the specific filing.
Max length: 71 characters
Paper Filing
Paper Filing Selection Text
Enter the paper-filing selection code or short identifier used on this form (for example enter '1' to indicate choosing the Paper Filing option).
Max length: 34 characters
Required Fees
Required Fees - Filing Fee: $25.00 Checkbox
Check this box if you are including or have paid the required $25.00 filing fee for the articles of cancellation.
Required Fees - Filing Fee Amount Number
Enter the filing fee amount to be paid for these articles of cancellation.
Max length: 49 characters
Required Fees - Reference Code Text
Enter the small reference code or short text shown next to the Required Fees label on the form (use the code or note provided by the form).
Max length: 27 characters
Signature Block (Signature, Date, Contact, Title, Business Contact)
Telephone Number (optional) Text
Enter the signer's telephone number (including area code) for contact; this field is optional.
Max length: 24 characters
Signature Text
Enter the signature of the authorized person signing this document.
Max length: 32 characters
Date Signed Date
Enter the date on which the authorized person signed this document.
Max length: 26 characters
Printed Name Text
Enter the full printed name of the person who is signing the document.
Max length: 32 characters
Title Text
Enter the signer's job title or official capacity within the company.
Max length: 26 characters
Email Address (optional) Text
Enter the signer's email address for contact; this field is optional.
Max length: 25 characters
Business Telephone Number (optional) Text
Enter the company's or signer's business telephone number (including area code); this field is optional.
Max length: 39 characters
Business Email Address (optional) Text
Enter the company's business email address for correspondence; this field is optional.
Max length: 32 characters