State of Alaska Department of Community and Economic Development Division of Banking, Securities, and Corporations CORPORATION SECTION PO Box 110808 Juneau AK 99811-0808 STATEMENT OF DISSOCIATION Limited Liability Partnership Pursuant to the provisions of the Alaska Statutes, the undersigned partner or partnership hereby files a Statement of Dissociation. 1. Name of the Limited Liability Partnership Alaska Entity #: 2. The partner listed below is dissociated from the partnership: Name of Partner or Partnership Mailing Address City, State, ZIP Code Foreign Limited Liability Partnerships must attach a certified copy of the statement from the state of domicile. A statement filed by a partnership must be executed by at least two partners or by a partner and another person authorized in the Statement of Partnership Authority. An individual who executes a statement as, or on behalf of, a partner or other person named as a partner in a statement shall personally declare under penalty of perjury that the contents of the statement are accurate. A person who files a statement shall promptly send a copy of the statement to every nonfiling partner and to any other person named as a partner in the statement. Failure to send a copy of a statement to a partner or other person does not limit the effectiveness of the statement as to a person who is not a partner. Signature of Partner or Authorized Person Printed Name Title Date 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 completed Statement of Dissociation and the $25.00 filing fee (in U.S. dollars) to: State of Alaska Corporations Section PO Box 110808 Juneau, AK 99811 For additional information or forms please visit our web site at: www.corporations.alaska.gov 08-507 (Rev. 8/5/04) ahl -1American LegalNet, Inc. www.USCourtForms.com