COVER LETTER TO: Registration Section Division of Corporations SUBJECT: Name of Limited Liability Company Dear Sir or Madam: The enclosed Statement of Abandonment of Conversion 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 CR2E135 (2/14) American LegalNet, Inc. www.FormsWorkFlow.com STATEMENT OF ABANDONMENT OF CONVERSION Pursuant to section 605.1044(3), Florida Statutes, I hereby submit the following Statement of Abandonment of Conversion prior to the effective date of the Articles of Conversion: FIRST: The name of the converting limited liability company is: SECOND: The date articles of conversion were delivered for filing is: THIRD: The conversion has been abandoned in accordance with s. 605.1044, Florida Statutes. _______________________________________ Authorized Representative of Converting Entity ___________________________________ Typed or Printed Name of Signature ___________________________________ Signature of Authorized Representative ____________________________________ Typed or Printed Name of Signature Filing Fee: $25.00 Certified Copy: $30.00 (optional) CR2E135 (2/14) American LegalNet, Inc. www.FormsWorkFlow.com