FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS Attached are the form and instructions to withdraw and cancel the certificate of authority of a foreign limited liability company. The requirements are as follows: Pursuant to s. 605.0910, Florida Statutes, the attached withdrawal application must be completed in its entirety. The fees are as follows: $25.00 Filing Fee $30.00 Certified Copy (optional) $ 5.00 Certificate of Status (optional) A letter of acknowledgment will be issued free of charge upon withdrawal. Submit one check made payable to the Florida Department of State for the total amount of the filing fee and any optional certificate or copy. A COVER letter should be submitted along with the application and check. The mailing address and courier address are noted below. Please send the application to: Mailing Address Registration Section Division of Corporations P.O. Box 6327 Tallahassee, FL 32314 Street/Courier Address Registration Section Division of Corporations Clifton Building 2661 Executive Center Circle Tallahassee, FL 32301 Any further inquiries concerning this matter should be directed to the Registration Section by calling (850) 245-6051. CR2E057 (2/14) American LegalNet, Inc. www.FormsWorkFlow.com COVER LETTER TO: Registration Section Division of Corporations SUBJECT: (Name of Foreign Limited Liability Company) Dear Sir or Madam: The enclosed withdrawal 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) For further information concerning this matter, please call: at ( (Name of Person) ) (Area Code & Daytime Telephone Number) STREET/COURIER ADDRESS: Registration Section Division of Corporations Clifton Building 2661 Executive Center Circle Tallahassee, Florida 32301 Enclosed is a check for the following amount: $25 Filing Fee $30 Filing Fee & Certificate of Status MAILING ADDRESS: Registration Section Division of Corporations P.O. Box 6327 Tallahassee, Florida 32314 $55 Filing Fee & Certified Copy $60 Filing Fee, Certificate of Status & Certified Copy American LegalNet, Inc. www.FormsWorkFlow.com NOTICE OF WITHDRAWAL OF CERTIFICATE OF AUTHORITY (Name of limited liability company) (Jurisdiction of its organization) (Date registered with Florida Department of State) (Florida Document Number) This limited liability company is withdrawing its certificate of authority in this state. (Signature of authorized representative) (Typed or printed name of signee) Filing Fee: $25.00 American LegalNet, Inc. www.FormsWorkFlow.com