File No.: Vermont Secretary of State APPLICATION FOR CERTIFICATE OF WITHDRAWAL of a Foreign (non-Vermont) Corporation (profit, nonprofit, or cooperative) PLEASE RETURN ACKNOWLEGDEMENT TO: (REQUIRED - NAME AND ADDRESS) Business ID: NAME ADDRESS Processed by: FOR OFFICE USE ONLY PLEASE REVIEW INSTRUCTIONS PAGE BEFORE BEGINNING. THIS DOCUMENT MUST BE TYPEWRITTEN OR PRINTED (11A V.S.A. � 1.20) 1. BUSINESS NAME: REQUIRED 2. STATEMENT OF WITHDRAWAL: REQUIRED This corporation is no longer transacting business in the state of Vermont and hereby surrenders its authority to transact business in this state. 3. SERVICE OF PROCESS PROVISIONS: REQUIRED a. This corporation hereby revokes the authority of its registered agent to accept service on its behalf. REQUIRED b. This corporation hereby 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 authorized to transact or was transacting without authorization business in this state. REQUIRED c. Upon withdrawal, the Vermont Secretary of State should forward all process served to the following: REQUIRED (1) (2) NAME: PHYSICAL STREET ADDRESS: NO PO BOX State/Province: ZIP/Postal Code: State/Province: ZIP/Postal Code: - City/Town: Country: (3) MAILING ADDRESS: City/Town: Country: This corporation hereby commits to notify the Vermont Secretary of State of all changes to this address for seven (7) years, following the effective date of this withdrawal. REQUIRED d. 4. EFFECTIVE DATE OF THIS WITHDRAWAL OPTIONAL MAY BE POST-DATED UP TO 90 DAYS FROM DATE OF RECEIPT CERTIFICATION OF APPLICATION: REQUIRED I hereby certify, under penalty of law (11A V.S.A. � 1.29 or 11B V.S.A. � 1.29), that I have the authority to execute this document as an officer or director of this entity currently on record with the Vermont Secretary of State, that the above information is accurate, is provided in duplicate with a Check or Money Order made payable to "VT SOS" in the amount of $20.00. Printed/Typed Name of Filer Signature Title PLEASE REVIEW INSTRUCTIONS ON REVERSE BEFORE FILING. Date American LegalNet, Inc. www.FormsWorkFlow.com 11A V.S.A. � 15.20/11B V.S.A. � 15.20 (REV. 07/01/15) DIVISION OF CORPORATIONS Page 1 of 1 FORM CORP-6(F) CORPORATION WITHDRAWAL Vermont Secretary of State APPLICATION FOR CERTIFICATE OF WITHDRAWAL of a Foreign (non-Vermont) Corporation (profit, nonprofit, or cooperative) A. This filing must be filed in duplicate (one original and one copy) with a check or money order, payable to "VT SOS," in the amount of $20.00 and a self addressed stamped envelope. B. This filing can only be accepted by Mail or In-person at: Submission Instructions Vermont Secretary of State Corporations Division 128 State Street Montpelier, VT 05633-1104 Note: This filing cannot be accepted by Phone, Fax or E-mail. C. Please allow 3-5 business days, from the day this is received in our office, for processing and 24 hours, following processing, for Website information to be updated and returned evidence to be sent. THIS FORM CANNOT be accepted by Phone, Fax, or E-mail; however, this filing is now available online: - If you wish to submit this filing electronically, DO NOT fill out THIS FORM, please file online at https://www.vtsosonline.com/online/Account. Payment for THIS FORM also CANNOT be accepted by credit card or e-check (ACH); however, payment by credit card or e-check (ACH) is available by filing online: - If you wish to submit payment by credit card or e-check (ACH), DO NOT fill out THIS FORM, please file online at https://www.vtsosonline.com/online/Account. Online filing normally takes 1 business day or less. ***THIS FILING IS NOW AVAILABLE ONLINE*** *************************************** Form Instructions Line 1. Required - Business Name exactly as currently on record with the Vermont Secretary of State, if unsure, please see https://www.vtsosonline.com/online/BusinessInquire/ Line 2. Lines 3a-d. Line 3c. Line 4. Required - Statement regarding the winding up of business in the state of Vermont. Required - Statements regarding the registered agent and service of process following withdrawal. Required - The point of contact for service of process following withdrawal. Optional - This withdrawal will be effective on the date received by this office - unless otherwise indicated on this line. a. This withdrawal may be post dated up to 90 days. b. If requested effective date is prior to date received, the effective date will be the date received. c. If requested effective date is more than 90 days follow date of receipt, this withdrawal will be rejected. Certification. Required - The document must be signed by an officer or director on record with the Vermont Secretary of State. For Questions, please contact Corporations Division at: corps@sec.state.vt.us or at 802-828-2386 American LegalNet, Inc. www.FormsWorkFlow.com 11A V.S.A. � 15.20/11B V.S.A. � 15.20 (REV. 07/01/15) DIVISION OF CORPORATIONS INSTRUCTION PAGE FORM CORP-6(F) CORPORATION WITHDRAWAL