Amendment Withdrawl (Foreign LLC) {111}

Amendment/Withdrawal - Foreign Limited Liability Company Secretary of State - Corporation Division - 255 Capitol St. NE, Suite 151 - Salem, OR 97310-1327 sos.oregon.gov/business - Phone: (503) 986-2200 Check the appropriate box below: AMENDMENT TO APPLICATION FOR AUTHORITY (Complete only 1, 2, 3, 9) WITHDRAWAL OF AUTHORITY TO TRANSACT BUSINESS (Complete only 1, 4, 5, 6, 7, 8, 9) REGISTRY NUMBER: In accordance with Oregon Revised Statute 192.410-192.490, the information on this application is public record. W e must release this information to all parties upon request and it will be posted on our website. For office use only Please Type or Print Legibly in Black Ink. Attach Additional Sheet if Necessary. 1) NAME: (Must contain the words Limited Liability Company or the abbreviations L or L.L.C.) AMENDMENT TO APPLICATION FOR AUTHORITY ONLY WITHDRAWAL OF AUTHORITY ONLY 2) INITIAL REGISTRATION DATE OF APPLICATION: 4) STATE OR COUNTRY OF ORGANIZATION: 3) AMENDMENT: (The amendment to the application for registration of foreign Limited Liability Company is as follows.) 5) SURRENDER OF AUTHORITY: This foreign limited liability company is not transacting business in Oregon, and surrenders its authority to transact business in Oregon. 6) REVOCATION OF AGENTS AUTHORITY: This foreign limited liability company revokes the authority of its registered agent to accept service on its behalf and 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 business in Oregon. 7) MAILING ADDRESS: (Address to which the person initiating any proceeding may mail to this corporation a copy of any process served on the Secretary of State.) 8) NOTIFICATION: The foreign Limited Liability Company will notify the Corporation Division, Business Registry of any change in this mailing address for a period of five years from the date of this withdrawal. 9) EXECUTION: (At least one member or manager must sign.) I declare as an authorized signer, under penalty of perjury, that this document does not fraudulently conceal, fraudulently obscure, fraudulently alter or otherwise misrepresent the identity of the person or any members, managers, employees or agents of the limited liability comp any. This filing has been examined by me and is, to the best of my knowledge and belief true, correct, and complete. Making false statements in this document is against the law and may be penalized by fines, imprisonment or both. Signature: Printed Name: Title: CONTACT NAME: (To resolve questions with this filing.) FEES Required Processing Fee $275 PHONE NUMBER: (Include area code.) Processing Fees are nonrefundable. Please make check payable to Corporation Division. Free copies are available at sos.oregon.gov/business, using the Business Name Search program. 111 - Amendment W ithdrawal - Foreign Limited Liability Company (11/17) American LegalNet, Inc. www.FormsWorkFlow.com