Department of Commerce, Community, and Economic Development Corporations, Business and Professional Licensing CORPORATIONS SECTION PO Box 110808 Juneau AK 99811-0808 APPLICATION FOR CERTIFICATE OF CANCELLATION Foreign Limited Liability Company Pursuant to Alaska Statutes, an application for cancellation filed by a foreign limited liability company must state: 1. Name of the limited liability company: Alaska Entity #: State of domicile: 2. The company is not conducting affairs in Alaska. 3. The company cancels its registration in Alaska. 4. 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 Alaska during the time the company was registered in this Alaska. 5. The mailing address where the Commissioner may mail any process against the corporation that may be served on the corporation: Name: Mailing Address: Physical Address if Mailing Address is a Post Office Box: City: Signature of Manager, Member or Attorney-in-Fact 08-476 (Rev. 08/05) alh State: Printed Name -1- ZIP Code: Title Date American LegalNet, Inc. www.USCourtForms.com If you have specific legal questions or concerns about this filing, you are strongly advised to consult an attorney or other professional to assist you. Mail the Application for Certificate of Cancellation and the $25.00 filing fee in U.S. funds to: State of Alaska Corporations Section PO Box 110808 Juneau AK 99801 For additional information or forms please visit our web site at: www.corporations.alaska.gov 08-476 (Rev. 08/05) alh -2- American LegalNet, Inc. www.USCourtForms.com