Application For Cancellation Of Assumed Corporate Name {SS-4405}

For Office Use Only APPLICATION FOR CANCELLATION OF ASSUMED CORPORATE NAME Corporate Filings 312 Rosa L. Parks Avenue 6th Floor, William R. Snodgrass Tower Nashville, TN 37243 Pursuant to the provisions of Section 48-14-10l(e) of the Tennessee Business Corporation Act or Section 48-54-l01(e) of the Tennessee Nonprofit Corporation Act, the undersigned corporation hereby submits this application: 1. The true name of the corporation is: 2. The state or country of incorporation is: 3. The corporation intends to cease transacting business under an assumed corporate name by cancelling it. 4. The assumed corporate name to be cancelled is: Signature Date Name of Corporation Signer's Capacity Signature Name (typed or printed) SS-4405 (Rev. 6/00) RDA 1678 American LegalNet, Inc. www.FormsWorkFlow.com