California State Board of Pharmacy Fax (916) 574-8618 DEPARTMENT OF CONSUMER AFFAIRS CERTIFICATE FOR CANCELLATION Name of Financial Institution (ISSUER): Address: City, State Zip: Name of Applicant/Licensee: Address: City, State Zip: IRREVOCABLE STANDBY LETTER OF CREDIT NO. Beneficiary: California State Board of Pharmacy The undersigned, a duly Authorized Representative of the California State Board of Pharmacy (Board) (as defined in the above referenced CREDIT), hereby certifies to the ISSUER that: 1.The license for which the credit was issued has expired or otherwise become inoperable, therebymaking the cancellation of the credit appropriate.2.The Board therefore requests the cancellation of the above-referenced CREDIT.THEREFORE, the undersigned has executed and delivered this CANCELLATION as of the day of , 20. CALIFORNIA STATE BOARD OF PHARMACYByVIRGINIA K. HEROLDExecutiveOfficer American LegalNet, Inc. www.FormsWorkFlow.com