COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Phone: (503) 986-2200 Fax: (503) 378-4381 Secretary of State Corporation Division 255 Capitol St. NE, Suite 151 Salem, OR 97310-1327 -againstFilingInOregon.com Index No. Amendment/Withdrawal - Foreign Limited Liability Company : Calendar No. Check the appropriate box below: : AMENDMENT TO APPLICATION FOR AUTHORITY JUDICIAL SUBPOENA Plaintiff(s) (Complete only 1, 2, 3, 9, 10) WITHDRAWAL OF AUTHORITY TO TRANSACT BUSINESS : (Complete only 1, 4, 5, 6, 7, 8, 9, 10) : 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. Defendant(s) Please Type . . Print . . . . . . . Black Ink.. . . . . .Additional .Sheet.if. Necessary. . . . . or . . . Legibly in . . . . . . Attach . . . . . . . . . . . . . . . . For office use only : ....... 1) NAME (Must contain the words “Limited Liability Company” or the abbreviations “LLC” or “L.L.C.”) THE PEOPLE APPLICATION FOR AUTHORITY ONLY AMENDMENT TO OF THE STATE OF NEW YORK WITHDRAWAL OF AUTHORITY ONLY 2) INITIAL REGISTRATION DATE OF APPLICATION 4) STATE OR COUNTRY OF ORGANIZATION 3) AMENDMENT (The amendment to the application for registration of foreign Limited Liability Company is as follows. Only the company name or duration can be amended. Attach a separate sheet if necessary.) 5) SURRENDER OF AUTHORITY TO This foreign limited liability company is not transacting business in Oregon, and surrenders its authority to transact business in Oregon. GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before 6) REVOCATION OF AGENT’S AUTHORITY , the Honorable at the Court This foreign limited liability company revokes the authority of its registered agent located at County of to accept service on its behalf and appoints the Secretary of State as its agent for in room , on the day of , 20 , atservice of process in anyin the based on a cause ofat any recessed o'clock proceeding noon, and action arising during the time it was or adjourned date, to testify and give evidence as a witness in this actionauthorized to transact business in Oregon. on the part of the 7) MAILING ADDRESS (Address to which the person initiating any proceeding may mail to this corporation a copy of any process served on the Secretary of State.) 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. 8) Witness, Honorable Court in County, NOTIFICATION , one of the Justices of the day of , 20 9) EXECUTION (At least one member or manager must sign.) Signature Printed Name The foreign Limited Liability Company 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. (Attorney must sign above and type name below) Title Attorney(s) for 10) CONTACT NAME (To resolve questions with this filing.) DAYTIME PHONE NUMBER (Include area code.) Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: 158 (Rev. 1/04) FEES Required Processing Fee $50 Confirmation Copy (Optional) $5 Processing Fees are nonrefundable. Please make check payable to “Corporation Division.” NOTE: 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.USCourtForms.com