COMMONWEALTH OF VIRGINIA STATE CORPORATION COMMISSION SCC636/835 (07/05) STATEMENT OF RESIGNATION OF REGISTERED AGENT _________________________________________________________________________________ (name of registered agent) hereby resigns his/her/its agency appointment as the registered agent for _________________________________________________________________________________. (name of corporation) _________________________________ (corporation’s SCC ID #) The registered office of the corporation is also discontinued. (MARK THIS BOX IF APPLICABLE) The above-named registered agent hereby certifies that a copy of this statement has been mailed to the principal office of the corporation by certified mail. _________________________________________________________________________________ (signature of individual serving as registered agent) (printed name) (date) OR _________________________________________________________________________________ (name of business entity serving as registered agent) By: _____________________________________________________________________________ (signature) (printed name and title) (date) It is a Class 1 misdemeanor for any person to sign a document he or she knows is false in any material respect with intent that the document be delivered to the Commission for filing. NOTICE TO THE CORPORATION The law requires each domestic and foreign corporation doing business in Virginia to continuously maintain in this Commonwealth a registered office and a registered agent. The corporation must establish a new registered office and/or a new registered agent by filing with the Commission form SCC635/834 (Statement of Change of Registered Office and/or Registered Agent). This form can be obtained from the Commission’s website at www.scc.virginia.gov/division/clk/asp/fee_corp_formrequest.aspx or by contacting the Clerk’s Office at (804) 371-9733 or toll-free in Virginia at (866) 722-2551. If the corporation fails to promptly establish a new registered office and/or registered agent, it may ultimately have its corporate existence terminated or its certificate of authority to do business in Virginia revoked. FOR SCC USE Date filed: __________________________ See instructions on the reverse. American LegalNet, Inc. www.USCourtForms.com INSTRUCTIONS The statement must be in the English language, typewritten or printed in black, legible and reproducible. The document must be presented on uniformly white, opaque paper, free of visible watermarks and background logos. You can download this form from our website at www.scc.virginia.gov/division/clk/fee_bus.htm. If the registered agent is a business entity, the statement must be executed in the name of the business entity by a person authorized to act on behalf of the registered agent, and the printed name and title of the person signing on behalf of the registered agent must be set forth next to the signature. Send the original, signed statement to the Clerk of the State Corporation Commission, P. O. Box 1197, Richmond, Virginia 23218-1197, (Street address: 1300 East Main St., Tyler Building, 1st Floor, Richmond, VA 23219). If you have any questions, please call (804) 371-9733 or toll-free in Virginia, 1866-722-2551. NOTE The agency appointment will be terminated and if so provided, the registered office discontinued, on the 31st day after the date on which the statement is filed with the Commission. See § 13.1-636, 13.1765, 13.1-835 or 13.1-927 of the Code of Virginia. American LegalNet, Inc. www.USCourtForms.com