For Office Use Only Corporate Filings 312 Rosa L. Parks Ave. 6th Floor, William R. Snodgrass Tower Nashville, TN 37243 NOTICE OF DISSOLUTION (LIMITED LIABILITY COMPANY) Pursuant to the provisions of §48-245-101 of the Tennessee Limited Liability Company Act, or pursuant to the provisions of §48-249-609 of the Tennessee Revised Limited Liability Company Act, the undersigned Limited Liability Company submits the following Notice of Dissolution: 1. The name of the Limited Liability Company is: ________________________________________________ 2. If any one of the following statements apply, please mark and complete: (a) Dissolution was approved by members pursuant to TCA §48-245-202(b) or §48-249-603(b), and [select one] the resolution was approved at a meeting held on ______________________________ date)[Date not required under TN Revised LLC Act];The requisite vote of the members was received. (or) the members validly took action without a meeting. Dissolution is based upon the expiration of the LLC duration pursuant to TCA §48-245-101(a)(1) or §48-249-601, and the expiration date is _______________________ (date). Dissolution is based upon termination of a member's interest pursuant to TCA §48-245-101(a)(5), and the continued membership of a member terminated on _____________________ (date). Dissolution is based upon the occurrence of the following event as specified in the articles or operating agreement pursuant to TCA §48-249-601 ____________________________________________________________________________________ ____________________________________________________________________________________ and the date of the event is ______________________ (date). (b) (c) (d) 3. If the document is not to be effective upon filing by the Secretary of State, the delayed effective date/ time is: ________________ , ___________ (date), ________________ (time). (A delayed effective date shall not be later than the 90th day after the date this document is filed by the Secretary of State) ______________________________________ Signature Date ______________________________________ Signer's Capacity ____________________________________________ Name of Limited Liability Company ____________________________________________ Signature ____________________________________________ Name (typed or printed) SS-4246 (Rev. 01/06) Filing Fee: $20 RDA 2458 American LegalNet, Inc. www.FormsWorkFlow.com