INTRASTATE 3 WITHDRAWAL OF OFFERING NY # Name of Issuer TO: ATTORNEY GENERAL OF THE STATE OF NEW YORK REAL ESTATE FINANC BUREAU NEW YORK, NEW YORK 10 The offering of the above issuer dated , as amended, is hereby withdrawn and abandoned. Listed below and on continuation sheets are the names and addresses of all persons who subscribed to this offering, the amount paid by each person and the amount returned to them as of . If less than the full amount has been returned, there is attached hereto a statement explaining why less than all funds have been returned and an accounting for the proceeds not returned. (If more space required, attach continuation sheets) STATE OF NEW YORK ) : ss.: COUNTY OF ) , bein g dul y sworn, deposes and sa y s that the above account is a true, accurate and complete statement of the withdrawal and abandonment of the offering of securities of (Issuer) of which your deponent is (Title) . Sworn to before me this da y of , 19 Notar y Public Name & AddressAmount Paid InAmount ReturnedDate American LegalNet, Inc. www.FormsWorkFlow.com