COVER LETTER TO: Registration Section Division of Corporations SUBJECT: Name of Limited Liability Company Dear Sir or Madam: The enclosed Amendment or Cancellation of Statement of Authority and fee(s) are submitted for filing. Please return all correspondence concerning this matter to the following: Name of Person Firm/Company Address City/State and Zip Code E-mail address: (to be used for future annual report notification) For further information concerning this matter, please call: at ( Name of Person Area Code ) Daytime Telephone Number STREET/COURIER ADDRESS: Registration Section Division of Corporations Clifton Building 2661 Executive Center Circle Tallahassee, Florida 32301 MAILING ADDRESS: Registration Section Division of Corporations P.O. Box 6327 Tallahassee, Florida 32314 CR2E145 (2/14) American LegalNet, Inc. www.FormsWorkFlow.com AMENDMENT OR CANCELLATION OF STATEMENT OF AUTHORITY Pursuant to section 605.0302(2), Florida Statutes, this limited liability company submits the following: FIRST: The name of the limited liability company is: SECOND: The Florida Document number of the limited liability company is: THIRD: The street address of the limited liability company's principal office is: The mailing address of the limited liability company's principal office is: FOURTH: The date the statement of authority became effective is: FIFTH: OR The amendment to the statement of authority is The statement of authority is cancelled. ____________________________________ Signature of authorized representative ________________________________ Typed or printed name of signature Filing Fee: $25.00 Certified Copy: $30.00 (optional) CR2E145 (2/14) American LegalNet, Inc. www.FormsWorkFlow.com