COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. APPLICATION FOR CERTIFICATE OF WITHDRAWAL : JUDICIAL Plaintiff(s) OF COOPERATIVE MARKETING ASSOCIATION SUBPOENA -against- : Wyoming Secretary of State The Capitol Building, Room 110 200 W. 24th Street Cheyenne, WY 82002-0020 : Phone (307) 777-7311/7312 Fax (307) 777-5339 E-mail: corporations@state.wy.us : Defendant(s) : ...................................................... FIRST: The name of the cooperative is: __________________________________________________ ________________________________________________________________________ THE PEOPLE OFformed under OF NEWof _________________________________________________. SECOND: It is THE STATE the laws YORK TO THIRD: It is no longer transacting business in this state; and it hereby surrenders its authority to transact business in the state of Wyoming. FOURTH: It GREETINGS: revokes the authority of its registered agent to accept service on its behalf and appoints the Secretary of State as its agent for service of process in any proceeding based on a cause of WE action arising duringthat time it was authorized to transact businessyou and each of you attend before COMMAND YOU, the all business and excuses being laid aside, in this state. , the Honorable at the Court located at Secretary of State may mail a copy of any process County of FIFTH: A mailing address to which the in room , on the day of , 20 , at o'clock in the noon, and at any recessed served on him under Item Four: or adjourned date, to testify and give evidence as a witness in this action on the part of the ________________________________________________________________________ ________________________________________________________________________ Your failure to comply with this subpoena is punishable aschange in itsof court and will make you liable to It will notify the Secretary of State in the future of any a contempt mailing address. the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Date:_________________________ Signed: ____________________________________ SIXTH: Witness, Honorable Court in County, , one of the Justices of the Title:______________________________________ day of , 20 ************************************************************************************ Filing Fee: $10.00 (Attorney must sign above and type name below) Instructions: 1. 2. Attorney(s) for The document shall be executed by the Chairman of Board of Directors or by its President or by another of its officers. The document shall be accompanied by one (1) exact or photo copy. Office and P.O. Address cma-cofw - Revised: 9/2003 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com