Wyoming Secretary of State State Capitol Building, Room 110 th 200 West 24 Street Cheyenne, WY 82002-0020 Ph. 307.777.7311 Fax 307.777.5339 Email: business@state.wy.us For Office Use Only Limited Liability Company Application for Certificate of Transfer The undersigned Limited Liability Company hereby applies for a Certificate of Transfer from the state of Wyoming, and for that purpose submits the following statements: 1. Limited liability company name: 2. It hereby requests a Certificate of Transfer from the state of Wyoming, and wishes to become formed under the laws of the state or nation of: 3. A statement that the limited liability company shall surrender its certificate of organization under this act upon the effectiveness of the transfer. 4. A statement that the transfer was duly approved by the members - see W.S. 17-29-1011(f). 5. The limited liability company shall maintain within the State of Wyoming an agent for service of process for at least one (1) year after the transfer is effected. The address of such registered office in Wyoming, and the name of the registered agent at that address is: LLC-CertificateTransfer – 07/01/2010 American LegalNet, Inc. www.FormsWorkFlow.com 6. Any other terms and conditions of the transfer. 7. A copy of the resolution authorizing the transfer from the state of Wyoming to the new jurisdiction is attached. Signature: ___________________________________________ (May be executed by a member, manager, or other authorized individual as set forth in the operating agreement.) Date: (mm/dd/yyyy) Print Name: Title: Contact Person: Daytime Phone Number: Email: Checklist Filing Fee: $50.00 Make check or money order payable to Wyoming Secretary of State. Please submit one originally signed document and one exact photocopy of the filing. Please review form prior to submitting to the Secretary of State to ensure all areas have been completed to avoid a delay in the processing of your documents. LLC-CertificateTransfer – 07/01/2010 American LegalNet, Inc. www.FormsWorkFlow.com