CORPORATION OR LIMITED LIABILITY COMPANY (LLC) STATEMENT OF RESIGNATION OF CORPORATION - $10.00 STATUTORY AGENT Pursuant to A.R.S. §§10-503(A) & 29-605 _______________________________________________ (Name of Corporation or LLC) LLC - NO FEE ______________________ (ACC file number) NOTE: It is critical that the Arizona Corporation Commission (ACC) receive the exact name and file number of the corporation or llc. Please check with our Customer Phone Bank, (602) 542-3026 or our web site, www.azcc.gov/divisions/corporations to obtain the correct information. IMPORTANT! YOU MUST COMPLETE THE ENTIRE FORM. 1) The undersigned statutory agent of: _______________________________________________________________________, (Name of Corporation or LLC) an Arizona Corporation, hereby resigns from my appointment as agent. a foreign corporation qualified to do business in Arizona, hereby resigns from my appointment as agent. an Arizona LLC, hereby resigns from my appointment as agent. a foreign LLC qualified to do business in Arizona, hereby resigns from my appointment as agent. 2) The known place of business, currently the street address of the undersigned, is also discontinued (please check box if this applies). 3) The undersigned has given notice of this resignation (required by A.R.S. §10-503(A) and §29605) to the entity by mailing one copy to the Corporation or LLC at the following address: ________________________________________________________________ ________________________________________________________________ This resignation shall be effective on the thirty-first day after the date on which this statement is delivered to the Arizona Corporation Commission for filing. Dated this _______ day of ________________________, __________ Signature: _______________________________________________ Printed Name: __________________________Title: ________________ ________________________________________________________ If signing on behalf of a company serving as statutory agent, print company name here This form must be delivered to: ARIZONA CORPORATION COMMISSION Corporations Division 400 West Congress, Suite #221 1300 West Washington or Tucson, Arizona 85701-1347 Phoenix, Arizona 85007-2929 AR: 0011 Rev: 09/2008 Arizona Corporation Commission Corporations Division American LegalNet, Inc. www.FormsWorkflow.com