COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : APPLICATION FOR WITHDRAWAL Calendar No. OF FOREIGN : JUDICIAL SUBPOENA Plaintiff(s) LIMITED LIABILITY COMPANY Submit in Duplicate : -against- John A. Gale, Secretary of: State Room 1301 State Capitol, P.O. Box 94608 Lincoln, NE 68509 : (402) 471-4079 Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . http://www.sos.state.ne.us. ...................... Name of Limited Liability Company_________________________________________ THE PEOPLE OF THE STATE OF NEW YORK _____________________________________________________________________ TO Organized under the laws of the State of _________________________ GREETINGS: The company is no longer transacting business in the State of Nebraska and surrenders its authority to transact businessthat thebusiness and excuses being laid aside, you and each of you attend before WE COMMAND YOU, in all state of Nebraska , the Honorable at the Court The of located at Countylimited liability company revokes the authority of its registered agent in this state to inaccept service of process and consents that ,service, in any action suit the proceeding based recessed room , on the day of 20 at o'clock in or noon, and at any upon any cause of action arising in this as a witness inthe time the limited liability company state during this action on the part of the or adjourned date, to testify and give evidence was authorized to transact business in this state be made on the company outside the state. Post office address at which process against the company may be served: Your failure to comply with this subpoena is punishable as 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 City State Zip Witness, Honorable Court in County, , one of the Justices of the day of , 20 ____________________________________ ___________________________________ Signature of Member Printed name of Member (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address FILING FEE: $25.00 Revised 12/19/2000 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Neb. Rev. Stat. 21-2642 American LegalNet, Inc. www.USCourtForms.com