COVER LETTER TO: Registration Section Division of Corporations SUBJECT: Name of Limited Liability Company DOCUMENT NUMBER: The enclosed Resignation of Registered Agent for a Limited Liability Company and fee are submitted for filing. Please return all correspondence concerning this matter to the following: Name of Person Name of 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 Enclosed is a check made payable to the Florida Department of State for $85.00 for an active limited liability company or $25.00 for an administratively dissolved, voluntarily dissolved or withdrawn limited liability company. MAILING ADDRESS: Registration Section Division of Corporations P.O. Box 6327 Tallahassee, FL 32314 STREET ADDRESS: Registration Section Division of Corporations Clifton Building 2661 Executive Center Circle Tallahassee, FL 32301 INHS17 (2/14) American LegalNet, Inc. www.FormsWorkFlow.com STATEMENT OF RESIGNATION OF REGISTERED AGENT FOR A LIMITED LIABILITY COMPANY Pursuant to the provisions of section 605.0115, Florida Statutes, the undersigned, , hereby resigns as Name of Registered Agent Registered Agent for , Name of Limited Liability Company Document Number, if known A copy of this resignation was mailed to the above listed limited liability company at its last known address. The agency is terminated and the office discontinued on the 31st day after the date on which this statement is filed. Signature of Resigning Agent If signing on behalf of an entity: Typed or Printed Name Capacity FILING FEES: $ 85.00 Active limited liability company $ 25.00 Administratively dissolved/ voluntarily dissolved/ withdrawn limited liability company Make checks payable to Florida Department of State and mail to: Division of Corporations P.O. Box 6327 Tallahassee, FL 32314 INHS17 (2/14) American LegalNet, Inc. www.FormsWorkFlow.com