State of Utah DEPARTMENT OF COMMERCE Division of Corporations & Commercial Code Application for Withdrawal of Registration of a Foreign Limited Liability Company File Number: _________________ __________________________________________________________________________________________________ Limited Liability Company Name SPECIAL NOTE: Utah law requires Limited Liability Companies seeking withdrawal to submit a Tax Clearance Certificate with the Application for Withdrawal. Please inquire with the Utah State Tax Commission at 210 N 1950 W Salt Lake City, Utah 84134. Phone: (801) 297-2200 or Toll Free: (800) 662-4335. Pursuant to the provisions of the Utah Limited Liability Company Act (U.C.A. 48-2c-1611), the undersigned limited liability company submits this Application for Withdrawal of Registration of a Foreign Limited Liability Company, and for this purpose declares: First: Filing date of articles of organization _________________________________________________; Second: It is organized under the laws of the State of ___________________________________________; Third: It is no longer transacting business in Utah; Fourth: It hereby surrenders its authority to transact business in Utah; Fifth: It revokes the authority of its registered agent in Utah to accept service of process, and consents that service of process in any action, suit or proceeding based upon any cause of action arising in Utah during the time the limited liability company was authorized to transact business in Utah may thereafter be made on the limited liability company by service thereof on the Division of Corporations and Commercial Code; Sixth: The address of its principal office, or if there is not one, the address to which the Division may mail a copy of any process against the limited liability company that may be served is: ________________________________________________________________________________ Address City State Zip Seventh: All outstanding fees and state tax obligations have been paid and the tax clearance certificate from the State Tax Commission is attached. Under penalties of perjury, I declare that this application for withdrawal has been examined by me and is, to the best of my knowledge and belief, true, correct and complete. Dated this _______________________________, 20 _____ By: ____________________________________________________________ Limited Liability Company Member or Manager Signature __________________________________________________________________ Typed Name & Title Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity. American LegalNet, Inc. www.FormsWorkflow.com