COVER LETTER TO: Registration Section Division of Corporations SUBJECT: (Name of Limited Liability Company) The enclosed member, resignation or dissociation and fee(s) are submitted for filing. Please return all correspondence concerning this matter to: (Contact Person) (Firm/Company) (Address) (City/State and Zip Code) For further information concerning this matter, please call: at ( ) (Area Code & Daytime Telephone Number) (Name of Contact Person) Enclosed please find a check made payable to the Florida Department of State for: $25 Filing Fee $55 Filing Fee & Certified Copy STREET/COURIER ADDRESS: Registration Section Division of Corporations Clifton Building 2661 Executive Center Circle Tallahassee, Florida 32301 CR2E079 (2/14) MAILING ADDRESS: Registration Section Division of Corporations P.O. Box 6327 Tallahassee, Florida 32314 American LegalNet, Inc. www.FormsWorkFlow.com FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS DISSOCIATION OR RESIGNATION OF MEMBER, MANAGER FROM FLORIDA OR FOREIGN LIMITED LIABILITY COMPANY (Pursuant to 605.0216, Florida Statutes) 1. The name of the limited liability company as it appears on the records of the Florida Department of State is: 2. The Florida document/registration number assigned to this limited liability company is: . 3. The date this member/manager withdrew/resigned or will withdraw/resign is: 4. I, (Print Name of Person Resigning) . , hereby withdraw/resign as a . (Print Title) of this limited liability company and affirm the limited liability company has been notified of my resignation in writing. Signature of Dissociating Member or Resigning Manager Filing Fee: Certified Copy: $25.00 (Required) $30.00 (Optional) CR2E079 (2/14) American LegalNet, Inc. www.FormsWorkFlow.com