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Cancellation Of Registration Form - Foreign Limited Liability Company - Office Of The Secretary Of The State Of Connecticut

CANCELLATION

OF REGISTRATION

FOREIGN LIMITED LIABILITY

COMPANY

Office of the Secretary of the State

30 Trinity Street / P.O. Box 150470 / Hartford, CT 06115-0470 / Rev. 120999

Please see reverse for instruction

Space For Office Use Only

Il. 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 1

Capacity of signatory

Signature

Cancellation Of Registration Form - Foreign Limited Liability Company - Office Of The Secretary Of The State Of Connecticut