Statement Of Withdrawal Of Limited Liability Partnership Status {UPA-1001(E)-1102f(F)}

DO NOT STAPLE FORM UPA-Withdrawal (1001(e)/1102(f)) Secretary of State Department of Business Services Limited Liability Division 501 S. Second St., Rm. 357 Springfield, IL 62756 217-785-8960 www.cyberdriveillinois.com Payment must be made by certified check, cashier's check, Illinois attorney's check, Illinois C.P.A.'s check or money order payable to Secretary of State. Illinois Uniform Partnership Act Statement of Withdrawal of Limited Liability Partnership Status Submit in Duplicate This space for use by Secretary of State. Date: Assigned File #: Filing Fee: $100 Approved: FILE # This space for use by Secretary of State. 1. Limited Liability Partnership Name: __________________________________________________________ 2. Federal Employer Identification Number (FEIN): ________________________________________________ 3. State of Jurisdiction: ______________________________________________________________________ 4. Effective Date of Initial Registration in Illinois:__________________________________________________ 5. Status as a Limited Liability Partnership is voluntarily withdrawn. 6. Address of Chief Executive Office (P.O. Box alone and c/o are unacceptable.): ________________________ ________________________________________________________________________________________ 7. Illinois Registered Agent: __________________________________________________________________ Illinois Registered Office (P.O. box alone and c/o are unacceptable.): ________________________________ ______________________________________________________________________________________ 8. We declare, under the penalty of perjury, under the laws of the State of Illinois, that the foregoing is true, correct and complete. Executed on the ___________of _______________ , ___________ by at least two partners. Day Month Year 1. Signature 1. Street Address Name and Title (type or print) City/Town Name if a Corporation or other Entity State, ZIP 2. Signature 2. Street Address Name and Title (type or print) City/Town Name if a Corporation or other Entity State, ZIP Printed by authority of the State of Illinois. May 2009 ­ 200 ­ RLLP 4.4 American LegalNet, Inc. www.FormsWorkFlow.com