255 CANCELLATION OF REGISTRATION OF FOREIGN LIMITED LIABILITY COMPANY (Instructions on back of application) 1. The name of the foreign limited liability company is: If different, the name the foreign limited liability company used in Idaho is: 2. The jurisdiction under whose laws the limited liability company is organized is: 3. The foreign limited liability company is not transacting business in Idaho, and it hereby surrenders its registration to transact business in Idaho. Signature Typed Name Capacity Secretary of State use only Revised 09/2002 5. Signature of an authorized person: g:\corp\forms\llc forms\cancellation LLC.pm6 4. The foreign limited liability company revokes the authority of its registered agent for service of process, and consents that service of process in any action which arose during the time it was registered in Idaho may hereafter be made by registered or certified mail addressed to: Web Form American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS Optional: If the document is incorrect where can you be reached for corrections? Note: Complete and submit the application in duplicate. 1. Line 1 - Enter the name of the limited liability company exactly as it appears in the office of the Idaho Secretary of State. 2. Line 2 - If the limited liability company was required to adopt a fictitious name to use in Idaho to avoid a name conflict or to comply with section 53-602, enter the name in the second portion of line 2. 3. Line 3 is a statement that is required by Idaho Code. 4. Line 4 - Enter the address to which service of process may be mailed after the cancellation of this limited liability company. 5. The application must be signed by a person authorized by the limited liability company. Please identify the name of the signer by typing his/her name below the signature and indicate in what capacity he/she signs. (For example: manager, member, etc.) 6. Enclose the appropriate fee: a. b. c. The filing fee is $20.00 If expedited service is requested, add $20.00 to the filing fee. If the fees are to be paid from the filing party’s pre-paid customer account, conspicuously indicate the customer account number in the cover letter or transmittal document. Pursuant to Idaho Code § 67-910(6), the Secretary of State’s Office may delete a business entity filing from our database if payment for the filing is not completed. 7. Mail or deliver to: Idaho Secretary of State of State Office of the Secretary 450 N 4th Street 700 West Jefferson PO Box 83720 PO Box 83720 Boise ID 83720-0080 Boise ID 83720-0080 8. If you have questions or need help, call the Secretary of State’s office at (208) 334-2301. American LegalNet, Inc. www.FormsWorkflow.com