COVER LETTER TO: Registration Section Division of Corporations SUBJECT: Name of Limited Liability Company Dear Sir or Madam: The enclosed Statement of Denial 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 STREET/COURIER ADDRESS: Registration Section Division of Corporations Clifton Building 2661 Executive Center Circle Tallahassee, Florida 32301 CR2E139 (2/14) Area Code ) Daytime Telephone Number MAILING ADDRESS: Registration Section Division of Corporations P.O. Box 6327 Tallahassee, Florida 32314 American LegalNet, Inc. www.FormsWorkFlow.com STATEMENT OF DENIAL Pursuant to section 605.0303, Florida Statutes, I hereby submit the following statement of denial: FIRST: The name of the limited liability company is: SECOND: The document number of this limited liability company is: THIRD: The statement of authority to which this statement of denial pertains is: and this grant of authority is denied. Signature of person submitting denial Typed or printed name of signature Filing Fee: $25.00 Certified Copy: $30.00 (optional) CR2E139 (2/14) American LegalNet, Inc. www.FormsWorkFlow.com