Mail all forms and required payment to: Department of Consumer and Regulatory Affairs Corporations Division PO Box 92300 Washington, DC 20090 Phone: (202) 442 - 44 32 Corporate Online Services Information: Many corporate filings are available by using CorpOnline Service. Go to CorpOnline site at https://corp online .dcra.dc.gov , create the profile, access the online services main page and proceed. Online filers must pay by using the credit card. District of Columbia Government Corporations Division Statement of Abandonment of A Plan of Interest Exchange of Domestic Filing Entity . Form G N - 10 , Ver. 2 , April 2018 . f Use this form to abandon a plan/statement of interest exchange. This form can only be used before a statementointerest exchange becomes effective. The statement of abandonment shall be effective upon filing ENTITY TYPE FILING F E E Domestic Filing Entity Refer to Corporate Fee Schedule posted online; Under the provisions of the Title 29 of D.C. Code (Business Organizations Act), the domestic filing entity listed below hereby applies for a Certificate of Abandonment and for that purpose submits the statement below. 1.1. The name of the acquired entity. 2. The date on which the statement of interest exchange was filed. 3. The interest exchanged has been a bandoned in accordance with section 247 29 - 20 3 .04. If you sign this form you agree that anyone who makes a false statement can be punished by criminal penalties of a fine up to $1000, imprisonment up to 180 days, or both, under DCOC 247 22 - 2405; 4 . Name of th e Governor or Authorized Person. 4A . Si gnature of the Governor or Authorized Person . 5 .Name of the Governor or Authorized Person. 5A . Signature of the Governor or Authorized Person. American LegalNet, Inc. www.FormsWorkFlow.com