Statement Of Withdrawal (LLC) {UT-SoWLLC}

State of Utah Department of Commerce Division of Corporations & Commercial Code Statement of Withdrawal Limited Liability Company Name: _____________________________________________________________ Entity Number: _______________________ This Statement of Withdrawal is filed to withdraw the ________________________________ filed on Type of Record Filed ____________________________ with an effective date of _________________________________. Date Filed with Division Effective Date of Record This Statement of Withdrawal is signed by: Each person that signed the record being withdrawn Fewer than all the persons that signed the record being withdrawn, but the record is withdrawn in accordance with the agreement of all the persons that signed the record. Under penalties of perjury, I declare that this Statement of Withdrawal has been examined by me and is, to the best of my knowledge and belief, true, correct and complete. By: ________________________________________ Title: ______________________ Date: _____________ By: ________________________________________ Title: ______________________ Date: _____________ By: ________________________________________ Title: ______________________ Date: _____________ Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity. American LegalNet, Inc. www.FormsWorkFlow.com