COVER LETTER TO: Registration Section Division of Corporations SUBJECT: Name of Limited Liability Company Dear Sir or Madam: The enclosed Statement of Termination 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: Name of Person at ( ) Area Code Daytime Telephone Number STREET/COURIER ADDRESS: Registration Section Division of Corporations Clifton Building 2661 Executive Center Circle Tallahassee, Florida 32301 CR2E141 (2/14) MAILING ADDRESS: Registration Section Division of Corporations P.O. Box 6327 Tallahassee, Florida 32314 American LegalNet, Inc. www.FormsWorkFlow.com STATEMENT OF TERMINATION Pursuant to section 605.0709(7), Florida Statutes, I hereby submit the following Statement of Termination: FIRST: The name of the limited liability company is: SECOND: The Florida Document number of the limited liability company is: THIRD: The date of filing of the initial articles of organization is: FOURTH: The date of filing of the dissolution is: _______________________________________. FIFTH: This limited liability company has completed winding up its activities and affairs and has determined that it will file a statement of termination. __________________________________ Signature of Authorized Representative ____________________________________ Typed or printed name of signature Filing Fee: $25.00 Certified Copy: $30.00 (optional) CR2E141 (2/14) American LegalNet, Inc. www.FormsWorkFlow.com