Mail all forms and required payment to: Department of Consumer and Regulatory Affairs Corporations Division PO Box 92300 Washington, DC 20090 Phone: (202) 442 - 44 32 Corporate Online Services Information: Many corporate filings are available by using CorpOnline Service. Go to CorpOnline site at https://corp online .dcra.dc.gov , create the profile, access the online services main page and proceed. Online filers must pay by using the credit card. District of Columbia Government Corporations Division Statement of Denial for Domestic Limited Liability Company Form DLC - 7 , Ver. 2 , April 201 8 . Use this form to allow for a person named in a filed statement of authority granting authority to deny it. ENTITY TYPE / AUTHORITY FILING F E E Domestic Limited Liability Company : 247 29 803.03. Refer to Corporate Fee Schedule posted online. Under the provisions of the Title 29 of D.C. Code (Business Organizations Act), the domestic filing entity listed below hereby applies for Certificate of Denial and for that purpose submits the statement below. 1 .1. Name of Limited Liability Company . 2. 3. T he caption of the statement of authority to which the statement of denial pertains 4. Denies the grant of authority . 5 . Effective Date. If you sign this form you agree that anyone who makes a false statement can be punished by criminal penalties of a fine up to $1000, imprisonment up to 180 days, or both, under DCOC 247 22 - 2405; 6 .Name of the Governor or Authorized Person. 6 A. Signature of the Governor or Authorized Person. American LegalNet, Inc. www.FormsWorkFlow.com