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Cancellation Of Registration Form - Foreign Limited Liability Company - Connecticut Secretary Of State (With Instructions)

CANCELLATION OF REGISTRATION

FOREIGN LIMITED LIABILITY COMPANY

Office of the Secretary of the State

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

860-509-6002

See reverse for instructions

Filing Fee: $60.00

Space For Office Use Only

1. NAME OF LIMITED LIABILITY COMPANY IN STATE OR COUNTRY OF FORMATION:

2. THE NAME UNDER WHICH THE LIMITED LIABILITY COMPANY TRANSACTS BUSINESS IN

CONNECTICUT, IF DIFFERENT FROM THE NAME STATED ABOVE:

3. STATE/COUNTRY OF FORMATION:

The undersigned asserts that the above named limited liability

company is not transacting business in Connecticut and surrenders its

certificate of registration to do so. It further revokes the authority of

its statutory agent for service of process and consents that process in

any action, suit or proceeding based upon any cause of action arising

in Connecticut during the time the limited liability company was

authorized to transact business in this state may be served upon the

Secretary of the State.

4. ADDRESS TO MAIL PROCESS SERVED UPON THE SECRETARY OF THE STATE PURSUANT

TO THE APPOINTMENT MADE ABOVE:

________________________________________________________

5. EXECUTION:

Dated this _____ day of _________, 20_____.

Print or type name of signatory

Capacity of signatory

Signature

REV. 05/25/2007

Cancellation Of Registration Form - Foreign Limited Liability Company - Connecticut Secretary Of State (With Instructions)