FILE ONE ORIGINAL (Two if you want a filedstamped copy returned to you) FEE: $25.00 - Expedite service is not available for this type of filing.In accordance with the provisions of the West Virginia Code 24747-9A-4(g) , the undersigned Business Trust hereby applies for a certificate of withdrawal from West Virginia, and submits the following statement: 1.The name of the Business Trust is: 2.It is formed under the laws of the State of: 3.The mailing address to which the Secretary of State may mail a copy of any process against the association: No. & Street AddressCity, State and Zip Code4.The Business Trust hereby attests that: It is not transacting business in West Virginia. It hereby surrenders its authority to transact business in West Virginia. It revokes the authority of its registered agent in West Virginia to accept service of process, and consents that service of process in any action, suit or proceeding based upon any course of action arising in West Virginia during the time the trust was authorized to transact business in West Virginia may thereafter be made on the trust by service thereof on the Secretary of State of West Virginia and commits to notify the Secretary of State of any changes of the trust222s mailing address. 5.Contact name and phone number. This information is optional, however, listing one may help expedite your filing and avoid any possible rejection of your filing if a problem is found. 6.Print name of signer: Title/Capacity of Signer: Signature*: Date: *Important Legal Notice Regarding Signature : Per West Virginia Code 24731D-1-129 . Penalty for signing false document. Any person who signs a document he or she knows is false in any material respect and knows that the document is to be delivered to the secretary of state for filing is guilty of a misdemeanor and, upon conviction thereof, shall be fined not more than one thousand dollars or confined in the county or regional jail not more than one year, or both. Phone Number Contact NameWest Virginia Secretary of State Business & Licensing Division Tel: (304)558-8000 Fax: (304)558-8381 Website: www.wvsos.govForm BT-4 Rev. 11/2017APPLICATION FOR CERTIFICATE OF WITHDRAWAL OF A BUSINESS TRUST American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR FILING A CERTIFICATE OF WITHDRAWAL OF A BUSINESS TRUST Withdrawal of a Business Trust in West Virginia requires several steps and may take some time. The process will go more quickly if the business trust222s trustees take care of all liabilities first, including filing any tax or employment reports and paying any outstanding taxes, assessments or penalties to the State of West Virginia. Filing fee is $25. Please make checks payable to the West Virginia Secretary of State. The Secretary of State will request, in writing, clearances from the West Virginia State Tax Department, Employer Coverage Unit (Workers Compensation) and Department of Employment Security. When those clearances have been received in writing by the Office of Secretary of State, which may take up to two years, a certificate of withdrawal will be prepared and mailed to the address indicated on the Articles of Withdrawal. You will be held liable for all taxes, fees, penalties, interest, etc. until clearances are obtained from all departments and divisions listed above. IF YOU NEED ADDITIONAL INFORMATION CONCERNING FILING FOR A WITHDRAWAL FOR YOUR COMPANY, PLEASE CONTACT OUR OFFICE AT 304-558-8000. Due to the nature of the withdrawal process, expedited service is not available for this filing. American LegalNet, Inc. www.FormsWorkFlow.com CHOOSE ONE OF THE FOLLOWING PROCESSING SERVICES: 1 STANDARD PROCESSING (5-10 business days) West Virginia Secretary of State Business & Licensing Division Tel: (304) 558-8000 Fax: (304) 558-8381 Website: www.wvsos.gov Filing Submission Instructions - Business DivisionSUBMIT THE COMPLETED APPLICATION WITH THE CUSTOMER ORDER REQUEST FORM TO ONE OF THE OFFICES BELOW. CHOOSE EXPEDITED OR STANDARD PROCESSING SERVICE. IF NOT USING THE CUSTOMER ORDER REQUEST FORM AND YOU ARE REQUESTING EXPEDITED SERVICE, YOU MUST INCLUDE THE WORD "EXPEDITE" AND THE LEVEL OF EXPEDITED SERVICE BEING REQUESTED (24-HOUR, 2-HOUR OR 1-HOUR) IN YOUR CORRESPONDENCE. BE SURE TO INCLUDE THE CORRECT ADDITIONAL EXPEDITED FEE. THIS FEE IS IN ADDITION TO THE REGULAR FILING FEE (SEE FEES BELOW).BUSINESS SERVICE CENTERS Standard and Expedited Filings Charleston Office One-Stop Business Center 1615 Washington Street East Charleston, WV 25311 Phone: (304) 558-8000 Fax: (304) 558-8381 Hours: Mon. - Fri. 8:30a - 5:00p EST Clarksburg Office North Central WV Business Center 200 West Main Street Clarksburg, WV 26301 Phone: (304) 367-2775 Fax: (304) 627-2243 Hours: Mon. -Fri. 9:00a - 5:00p EST Martinsburg Office Eastern Panhandle Business Center 229 E. Martin Street Martinsburg, WV 25401 Phone: TBA Fax: TBA Hours: Mon. - Fri. 9:00a - 5:00p ESTIMPORTANT: READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING FORMS. Please follow the instructions included with the application. Failure to include any of the required information on the form may cause the filing to be rejected.All forms may be downloaded from our web site www.wvsos.gov . Rev. 11/2017 SUBMIT COMPLETED FILING TO ONE OF THE BUSINESS CENTERS BELOW: INCLUDE PAYMENT: Be sure to enclose the correct filing fee with your filing. If paying by credit card, be sure to include the e-Payment Authorization form with your filing. Your filing will be rejected if the payment is not included or if the e-Payment Authorization form is not included if paying by credit card. Standard filing fees apply.STANDARD PROCESSING requests may be submitted by: - E-mail to CorpFilings@wvsos.gov - Fax - Walk in delivery (drop off service only filed within 5-10 business days) American LegalNet, Inc. www.FormsWorkFlow.com West Virginia Secretary of State Business & Licensing Division Tel: (304)558-8000 Fax: (304)558-8381 Website: www.wvsos.gov E-mail: CorpFilings@wvsos.gov Customer Order RequestSUBMIT THIS COMPLETED FORM WITH YOUR FILING. Order Processing Requested*: Standard Processing* Name of Entity: Return filing to: (Return Address) Contact Name: Phone: Return Delivery Options: Email or Fax options do not receive a copy via mail; must be ordered separately. Email to: Fax to: Hold for Pick Up UPS: Acct # Other (explain below): FedEx: Acct # Mail to Return Address above Order Description (include items being ordered and fee breakdown): * PLEASE NOTE: Original paperwork is kept by this office. Include a copy of the original filing if you want a file stamped copy returned to you at no extra charge. Certified copy requests are an additional $15 per certified copy being requested. Total Amount: Payment Method: Cash (Do Not mail cash) Pre-paid Acct #: Credit Card (Must attach e-Payment Authorization request form including payment information.) Check/Money Order(Avg. processing turnaround 5-10 business days)Rev. 11/2017*"Processing" indicates the filing will be completed and registered in the Secretary of State registration database.Attach signed pre-paid slip. American LegalNet, Inc. www.FormsWorkFlow.com e-Payment Authorization Credit Card Number: Card Type: Service Type: Fax Mail E-mail Visa Mastercard Discover American Express Payment Information Storage Authorization Year: Entity Name: Name as it appears on the account Billing Address City State Zip Code Telephone Ext.I authorize the Secretary of State to store this payment information for future payment transactions processed by Secretary of State: Authorized Signature X (required) (optional) DateThis document contains confidential financial information and will be properly shredded after payment has been processed by this office. Electronic storage of payment information is only permitted by signed authorization below which may be retracted at any time by written request by the authorized party.Not to Exceed Amount: USD $ Date Month: V Code** 3-digit number on back of VISA, MasterCard and Discover cards. 4-digit number on front right side of American Express card.NOTICE: For security and verification purposes, all credit card payments must include the 3- or 4-digit CVV2 code (V Code) n