Filing Fee $90.00 FOREIGN LIMITED LIABILITY COMPANY STATE OF MAINE _____________________ Deputy Secretary of State CANCELLATION OF AUTHORITY TO DO BUSINESS A True Copy When Attested By Signature ______________________________________ (Name of Limited Liability Company in Jurisdiction of Organization) _____________________ Deputy Secretary of State Pursuant to 31 MRSA §717, the undersigned foreign limited liability company hereby cancels its authority to do business in the State of Maine and states the following: FIRST: If different, the name under which the limited liability company applied for authority to do business in the State of Maine pursuant to §603-A.1 and/or §605-A is ________________________________________________________________________________________________ SECOND: The jurisdiction of its organization is _________________________________________________________________ THIRD: The date on which it was authorized to do business in the State of Maine is __________________________________ FOURTH: The limited liability company is not as of the date of this application for cancellation doing business in Maine and hereby cancels its authority to do business in this State. FIFTH: The limited liability company revokes the authority of its registered agent in Maine to accept service of process; it consents that process in any action, suit or proceeding based upon any cause of action arising in Maine prior to the date of filing this application may be served on the Secretary of State after the date of the filing of this application. SIXTH: The address of the principal or registered office of the limited liability company, wherever located, is ________________________________________________________________________________________________ (street, city, state and zip code) FORM NO. MLLC-12B (1 of 2) American LegalNet, Inc. www.FormsWorkFlow.com DATED __________________________ Authorized Signature(s)* ___________________________________________________ (signature) ___________________________________________________ (type or print name and capacity) For Authorized Signature(s) on behalf of Entities Name of Entity _________________________________________________________________________________________________ By ________________________________________________ ___________________________________________________ (authorized signature) (type or print name and capacity) *Certificate MUST be signed by: (1) at least one manager OR (2) at least one member if the limited liability company is managed by the members OR (3) any duly authorized person. The execution of this certificate constitutes an oath or affirmation under the penalties of false swearing under 17-A MRSA §453. Please remit your payment made payable to the Maine Secretary of State. SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE, 101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101 FORM NO. MLLC-12B (2 of 2) Rev. 8/1/2004 TEL. (207) 624-7752 American LegalNet, Inc. www.FormsWorkFlow.com