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Form 0017-07/12 - Certificate Of Withdrawal - Foreign Corparation - Oklahoma Secretary Of State

CERTIFICATE OF WITHDRAWAL

(Foreign Corporation)

Filing Fee: $100.00

TO: OKLAHOMA SECRETARY OF STATE

2300 N Lincoln Blvd., Room 101, State Capitol

Oklahoma City, Oklahoma 73105-4897

(405) 522-2520

PLEASE NOTE:

In the event the corporation was dissolved in the jurisdiction of its incorporation, a copy of the certificate of dissolution issued

by the proper official of such jurisdiction MUST BE ATTACHED HERETO.

In the event the corporation was dissolved by a court order or decree, a copy of the order or decree, certified by the court clerk

or other official body, under the official seal of the court or official body or clerk thereof MUST BE ATTACHED HERETO.

I hereby execute the following articles for the purpose of surrendering a foreign corporation’s authority to transact

business in the state of Oklahoma pursuant to the provisions Title 18, Section 1135:

1. Name of the corporation:

2. If different, the fictitious name which the company transacts business under in the state of Oklahoma:

3. State or other jurisdiction of its formation:

4. The corporation hereby revokes the authority of its registered agent in Oklahoma to accept service of process and

consents that process against the corporation in any action, suit or proceeding, based upon any cause of action

arising in Oklahoma during the time the corporation was authorized to transact business in this state, may be served

upon the Oklahoma Secretary of State in the manner provided by law.

5. Address to which service of process against the corporation may be mailed:

Street Address

City

State

Zip Code

The certificate of withdrawal must be signed by the president or vice president of said corporation

and attested to by its secretary or assistant secretary.

• Signed this

day of

by:

Signature of President or Vice President

Attested to by:

Printed Name

Signature of Secretary or Assistant Secretary

Printed Name

(SOS FORM 0017-07/12)

Form 0017-07/12 - Certificate Of Withdrawal - Foreign Corparation - Oklahoma Secretary Of State