Cancellation Of Registration Form - Foreign Statutory Trust

Cancellation Of Registration Form - Foreign Statutory Trust - 2007

CANCELLATION OF REGISTRATION

FOREIGN STATUTORY TRUST

MAILING ADDRESS:

DELIVERY ADDRESS:

Commercial Recording Division

Connecticut Secretary of the State

P.O. Box 150470

30 Trinity Street

Hartford, CT 06115-0470

Hartford, CT 06106

860-509-6003

Filing Fee: $60.00

Make Checks Payable To “Secretary of the State”

Space For Office Use Only

1. NAME OF STATUTORY TRUST IN ITS STATE OR COUNTRY OF FORMATION:

2. IF DIFFERENT FROM THE ABOVE, THE NAME UNDER WHICH STATUTORY TRUST TRANSACTS

BUSINESS IN CONNECTICUT:

3. STATE OR COUNTRY OF FORMATION:

The statutory trust is not transacting business in Connecticut and surrenders its authority to transact

further business therein.

The statutory trust further revokes the authority of its registered agent to accept service of process on its

behalf.

The statutory trust appoints the Secretary of the State as its agent for service of process and consents to

service of process thereon in any action, suit or proceeding based on a cause of action arising during the

time it was authorized to transact business in this state.

4. THE ADDRESS TO WHICH THE SECRETARY OF THE STATE MAY MAIL ANY PROCESS

SERVED UPON HIM IN ACCORDANCE WITH THE ABOVE STATED APPOINTMENT:

___________________________________________

(Number and street or P.O. Box)

___________________________________________

(City, State and Zip Code)

5. EXECUTION

Dated this _____ day of _________, 20______.

Print or type name of signatory

Capacity of signatory

Signature

Rev. 08/24/2007

Cancellation Of Registration Form - Foreign Statutory Trust - 2007