COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : STATE OF SOUTH CAROLINA JUDICIAL SUBPOENA Plaintiff(s) SECRETARY OF STATE -against- : RESIGNATION OF REGISTERED AGENT AND : DISCONTINUANCE OF REGISTERED OFFICE OF A SOUTH CAROLINA OR : FOREIGN NONPROFIT CORPORATION Defendant(s) : ...................................................... PLEASE TYPE OR PRINT IN BLACK INK Pursuant to Sections 33-31-503 of the South Carolina Code of Laws, as amended, the undersigned hereby submits the following: THE PEOPLE OF THE STATE OF NEW YORK 1. TO The name of the Corporation that is affected by this document is The date of Incorporation is_____________________________ 2. [ ] That the undersigned resigns as the registered agent of the above named corporation effective GREETINGS: st day after the date on which this document is filed in the Office of the Secretary of State. the 31 3. [ ] WE COMMAND YOU, that all business and excuses which laid aside, you and each theyou attend before That the above named corporation's registered office, being is the business office of of st registered agent, is discontinued, effective the 31 day after the date on which this document is , the Honorable at the Court located at County offiled in the Office of the Secretary of State. in room , on the day of , 20 , at o'clock in the noon, and at any recessed orDate: _____________________ evidence as a witness______________________________________ adjourned date, to testify and give in this action on the part of the Signature ______________________________________ Type or as Name Your failure to comply with this subpoena is punishablePrinta 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. Witness, Honorable Court in County, , one of the Justices of the day of , 20 FILING INSTRUCTIONS 1. Three copies of this document, the original and either two duplicate originals or two conformed copies, must be filed. 2. Filing fee (payable to the Secretary of State at the time of filing this document): (Attorney must sign above and type name below) Agent's Statement of Resignation Discontinuance of Registered Office Total $ 3.00 2.00 Attorney(s) $ 5.00 for Return to: Secretary of State P.O. Box 11350 Columbia, SC 29211 Office and P.O. Address FRN-RESIGNATION OF REGISTERED AGENT.doc Telephone No.: Form Revised by South Carolina Facsimile No.: Secretary of State, January 2000 E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com