MINNESOTA SECRETARY OF STATE APPLICATION OF FOREIGN LIMITED LIABILITY COMPANY FOR A CERTIFICATE OF WITHDRAWAL FROM MINNESOTA READ THE INSTRUCTIONS BEFORE COMPLETING THIS FORM 1. The name of the Limited Liability Company is: ___________________________________________________________________________________________________ 2. The Limited Liability Company, which is a __________________________________________Limited Liability Company (List the state or country of formation) authorized to transact business in Minnesota hereby applies for a Certificate of Withdrawal. This Limited Liability Company has no property located in Minnesota and has ceased to transact business in Minnesota. The Limited Liability Company surrenders its authority to transact business in Minnesota and revokes the authority of its registered agent to accept service of process. The Limited Liability Company consents to the service of process in any action, suit, or proceeding based on any cause of action arising in this state during the time the Limited Liability Company was authorized to transact business in this state may be made on the Limited Liability Company by service upon the Secretary of State. 3. Any process that may be served upon the Secretary of State of Minnesota after the withdrawal of this Limited Liability Company from Minnesota should be forwarded to: __________________________________________________________________________________________________ (Name) ___________________________________________________________________________________________________ (Address) (City) (State) (Zip) 4. I certify that I am authorized to execute this application and I further certify that I understand that by signing this application I am subject to the penalties of perjury as set forth in Minnesota Statutes, section 609.48, as if I had signed this application under oath. __________________________________________________ (Authorized Person) ForeignLLCWithdrawalRev.08-01-10 American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS Retain the original signed copy of this document for your records and submit a legible photocopy for filing with the Secretary of State. 1. List the full legal name of the Limited Liability Company used in Minnesota. 2. List the name of the state, province or country in which the entity was originally incorporated. 3. List the name and address of the individual or company to which service of process should be forwarded after the filing of this withdrawal application. 4. The application for withdrawal must be signed by an authorized person or by an authorized agent (The signing party must indicate on the document that they are acting as the agent of the person(s) whose signature would be required and that they have been authorized to sign on behalf of that person(s).). FILING FEES: $35.00 Payable to the MN Secretary of State FILE IN-PERSON OR MAIL TO: Minnesota Secretary of State - Business Services Retirement Systems of Minnesota Building 60 Empire Drive, Suite 100 St Paul, MN 55103 (Staffed 8:00 - 4:00, Monday - Friday, excluding holidays) To obtain a copy of a form you can go to our web site at www.sos.state.mn.us , or contact us between 9:00am to 4:00pm, Monday through Friday at (651) 296-2803 or toll free 1-877-551-6767. All of the information on this form is public. Minnesota law requires certain information to be provided for this type of filing. If that information is not included, your document may be returned unfiled. This document can be made available in alternative formats, such as large print, Braille or audio tape, by calling (651)296-2803/voice. For a TTY/TTD (deaf and hard of hearing) communication, contact the Minnesota Relay Service at 1-800-627-3529 and ask them to place a call to (651)296-2803. The Secretary of State's Office does not discriminate on the basis of race, creed, color, sex, sexual orientation, national origin, age, marital status, disability, religion, reliance on public assistance or political opinions or affiliations in employment or the provision of service. American LegalNet, Inc. www.FormsWorkFlow.com