Print Form For Office Use Only Corporate Filings 312 Rosa L. Parks Avenue 6th Floor, William R. Snodgrass Tower Nashville, TN 37243 STATEMENT OF WITHDRAWAL OF A REGISTERED FOREIGN LIMITED LIABILITY PARTNERSHIP To the Secretary of the State of Tennessee: Pursuant to the provisions of the Tennessee Uniform Partnership Act, Section 61-1-1004, the undersigned general partner(s) hereby execute(s) the following certificate of cancellation of registration: 1. The name of the foreign limited liability partnership is If different, the name under which the foreign limited liability partnership is registered is 2. The state or country under whose law it was registered is 3. The foreign limited liability partnership is not transacting business in the State of Tennessee and surrenders its registration to transact business in this state. 4. Please mark the applicable statement: The foreign limited liability partnership continues its registered agent and registered office in the State of Tennessee. The foreign limited liability partnership hereby 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 registered to transact business in this state. The mailing address (including zip code) to which the Secretary of State may mail a copy of any process served on him is: 5. The undersigned foreign limited liability partnership makes the commitment to notify the Secretary of State in the future of any change in its mailing address. 6. If the document is not to be effective upon filing by the Secretary of State, the delayed effective date/time is: , (date), (time). [NOTE: A delayed effective date may not be later than the 90th day after this document is filed by the Secretary of State.] Signature Date Signature Signer's Capacity Name (typed or printed) SS-4484 (Rev. 10/08) Filing Fee: $20.00 RDA 2515 American LegalNet, Inc. www.FormsWorkFlow.com