Phone: (503) 986-2200 Fax: (503) 378-4381 Application for Amendment/Withdrawal—Foreign Corporation Secretary of State Corporation Division 255 Capitol St. NE, Suite 151 Salem, OR 97310-1327 FilingInOregon.com Check the appropriate box below: AMENDMENT TO APPLICATION FOR AUTHORITY (Complete only 1, 2, 8, 9) WITHDRAWAL OF AUTHORITY TO TRANSACT (Complete only 3, 4, 5, 6, 7, 8, 9) REGISTRY NUMBER: In accordance with Oregon Revised Statute 192.410-192.490, the information on this application is public record. We must release this information to all parties upon request and it will be posted on our website. For office use only Please Type or Print Legibly in Black Ink. Attach Additional Sheet if Necessary. AMENDMENT TO APPLICATION ONLY 1) ENTITY NAME 2) AMENDMENT (The amendment is as follows.) WITHDRAWAL OF AUTHORITY TO TRANSACT BUSINESS ONLY 3) NAME 4) STATE OR COUNTRY OF INCORPORATION 5) THIS CORPORATION IS NOT TRANSACTING BUSINESS IN OREGON, AND SURRENDERS ITS AUTHORITY TO TRANSACT BUSINESS IN OREGON. 6) THIS CORPORATION REVOKES THE AUTHORITY OF ITS REGISTERED AGENT TO ACCEPT SERVICE ON ITS BEHALF AND APPOINTS THE SECRETARY OF STATE AS ITS AGENT FOR SERVICE OF PROCESS IN ANY PROCEEDING BASED ON A CAUSE OF ACTION ARISING DURING THE TIME IT WAS AUTHORIZED TO TRANSACT BUSINESS IN OREGON. 7) MAILING ADDRESS (The address to which the person initiating any proceeding may mail to this Corporation a copy of any process served on the Secretary of State. The Corporation will notify the Corporation Division, Business Registry of any change in this mailing address for a period of five years from the date of this withdrawal.) 8) EXECUTION Signature Printed Name 9) CONTACT NAME (To resolve questions with this filing.) DAYTIME PHONE NUMBER Title FEES (Include area code.) Required Processing Fee $50 Confirmation Copy (Optional) $5 Processing Fees are nonrefundable. Please make check payable to “Corporation Division.” NOTE: 123 (Rev. 8/07) Fees may be paid with VISA or MasterCard. The card number and expiration date should be submitted on a separate sheet for your protection. American LegalNet, Inc. www.FormsWorkflow.com