COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : CERTIFICATE OF WITHDRAWAL Calendar No. TO TRANSACT : JUDICIAL SUBPOENA Plaintiff(s) BUSINESS IN THE STATE OF NEBRASKA -against: John A. Gale, Secretary of: State Room 1301 State Capitol, P.O. Box 94608 Lincoln, NE 68509: http://www.sos.state.ne.us Defendant(s) : ...................................................... Submit in Duplicate (returned file stamped copy is your certificate of withdrawal) THE PEOPLE OF THE STATE OF NEW YORK _____________________________________________________________________ Name of Corporation TO Incorporated under the laws of_____________________________desires to withdraw its authority to transact business in the State of Nebraska. GREETINGS: This corporation is no longer transacting business in the State of Nebraska and surrenders WE COMMAND business in business and Nebraska. its authority to transactYOU, that all the State of excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County corporation revokes the authority of its registered agent to accept service of process of This in room , on the day , 20 , o'clock on its behalf and consents that of service of process in at proceedingin the the time it at any recessed any during noon, and was or adjourned date, to testify and give evidence as a witness in this action on the part of the authorized to transact business in the state may be made on this corporation at the following address: Your failure to comply with this subpoena is punishable as be served: Mailing Address at which process against corporation may a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. _____________________________________________________________________ Street Address Witness, Honorable Court in County, City State Zip , one of the Justices of the day of , 20 DATED_______________________ ________________________________ Signature (Attorney must sign above and type name below) ________________________________ Printed Name/Title Attorney(s) for NOTE: Every filing must be signed by the chairperson of the board of directors, the president, or one of the officers of the corporation. If the corporation has not yet been formed or directors have not yet been selected, the filing shall be signed by an incorporator. If the corporation is in the hands of a receiver, trustee, or other court appointed fiduciary, the filing shall be signed by that fiduciary. Office and P.O. Address FILING FEE: $30.00 Revised 12/19/2000 Telephone No.: Facsimile No.: Neb. E-Mail Address: Rev. Stat. 21-20,178 Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com