Application For Cancellation By Foreign Limited Liability Company {FL-04}

NO FEE APPLICATION FOR CANCELLATION BY FOREIGN LIMITED LIABILITY COMPANY (PLEASE TYPE OR PRINT CLEARLY IN INK) The undersigned, pursuant to , sets forth the following: 1.Foreign Limited Liability Company Name: 2.State of Organization: 3.The Foreign Limited Liability Company is not transacting business in this State and hereby surrenders its authority todo so. 4.The Foreign Limited Liability Company revokes the authority of its registered agent to accept service on its behalfand appoints the Secretary of State as its agent for service of process in any action, suit or proceeding based on acause of action arising during the time it was authorized to transact business in this State. The Arkansas Secretaryof State shall hereafter be the authorizing recipient of service for valid service of process on this Foreign LimitedLiability Company. 5. I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days. Executed this day of , . Authorizing Officer and Title (Type or Print)Authorized Signature 001027021n024030n030007r013027r031n027035025016007031n031r$'#$t 003n026020031025022037004020031031022r006025013021 FL-04 Rev. American LegalNet, Inc. www.FormsWorkFlow.com