BUSINESS REGISTRATION DIVISION P.O. BOX 29622 (Revised August 2017) R 27626-0622 Form L-14 Instructions for Filing APPLICATION FOR CERTIFICATE OF WITHDRAWAL LIMITED LIABILITY COMPANY Item 1 Enter the name of the foreign LLC and if different, the name provided in the foreign LLC's certificate of authority that the foreign LLC is authorized to use to transact business in North Carolina. Item 2 Enter the state or country of organization. Item 3 See form. Item 4 See form. Item 5 Enter the complete address to which the Secretary of State may send a copy of any process served pursuant to the paragraph above. Item 6 See form. Item 7 The document will be effective on the date and at the time of filing, unless a delayed date or an effective time (on the day of filing) is specified. If a delayed effective date is specified without a time, the document will be effective at 11:59 p.m. Raleigh, North Carolina time on the day specified. If a delayed effective date is specified with a time, the document will be effective on the day and at the time specified. A delayed effective date may be specified up to and including the 90th day after the day of filing. Date and Execution Enter the date the document was executed. In the blanks provided enter: 225The name of the limited liability company as it appears in item 1.225The signature of the Manager or other Company Official of the limited liabilitycompany executing the document.225The name and title of the above-signed representative. American LegalNet, Inc. www.FormsWorkFlow.com BUSINESS REGISTRATION DIVISION P.O. BOX 29622 (Revised August 2017) R 27626-0622 Form L-14 State of North Carolina Department of the Secretary of State APPLICATION FOR CERTIFICATE OF WITHDRAWAL OF LIMITED LIABILITY COMPANY Pursuant to 24757D-7-20 of the General Statutes of North Carolina, the undersigned limited liability company hereby applies to the Secretary of State for a Certificate of Withdrawal and for that purpose submits the following statement. 1.The name of the foreign limited liability company is: . 2.The limited liability company is organized under the laws of: . 3.The limited liability company is not transacting business in the State of North Carolina and surrenders itsauthority to transact business in this State. 4.The limited liability company revokes the authority of its registered agent to accept service of process andconsents that service of process in any action or proceeding based upon any cause of action arising in the Stateof North Carolina, or arising out of business transacted in North Carolina, during the time the limited liabilitycompany was authorized to transact business in North Carolina may hereafter be made on such limited liabilitycompany by service thereof on the Secretary of State. 5.The mailing address to which the Secretary of State may mail a copy of any process served on him/her pursuantto the paragraph above is: C/O Number and Street: City: State: Zip Code: County: 6.The limited liability company hereby agrees to notify the Secretary of State of any changes in its mailingaddress. 7.This application will be effective upon filing, unless a date and/or time is specified: . This the day of , 20 . Name of Limited Liability Company Signature Type or Print Name and Title Notes: 1.Filing fee is $10. This application and one exact or conformed copy of this application must be filed with the Secretary ofState. American LegalNet, Inc. www.FormsWorkFlow.com