An application for cancellation filed by a foreign limited liability company must state (1) the name of the company and the state or other jurisdiction where the company was organized;
(2) that the company is not conducting affairs in this state;
(3) that the company cancels its registration in this state;
(4) that the company revokes the authority of its registered agent for service of process in this state and consents that service of process may subsequently be made on the company by service on the commissioner for a cause of action arising in this state during the time the company was registered in this state; and
(5) an address for mailing a copy of a process to the company.