Natalie E. Tennant Secretary of State State Capitol Bldg. 1900 Kanawha Blvd. East Charleston, WV 25305 Penney Barker, Manager Process Section Tel. 304-558-6000 Fax 304-558-8381 Hrs. 8:30am – 5:00pm ET www.wvsos.com File one original application along with two copies of the application 1. STATEMENT OF RESIGNATION OF A REGISTERED AGENT The name of business entity is: 2. The registered office will continue to be: ____________________________________________________________________ address city, state, zip or The current registered office will be discontinued. 3. I, ________________________________ hereby resign as registered agent of the entity above named business 4. Signature of Agent Resigning: ____________________________________________ 5. Date: Note: The agency appointment is terminated on the thirty-first day after the date on which the statement was filed. Revised 1/09 American LegalNet, Inc. www.FormsWorkflow.com