COVER LETTER 
                                        
TO: Registration Section 
    Division of Corporations 
 
SUBJECT:                                                                                            
                                   Name of Limited Liability Company 
                                        
Dear Sir or Madam: 
 
The enclosed Statement of Abandonment of Domestication and fee(s) are submitted for filing. 
 
Please return all correspondence concerning this matter to the following: 
 
                      Name of Person 
 
                      Firm/Company 
 
                   Address 
 
           City/State and Zip Code 
 
 E-mail address: (to be used for future annual report notification) 
 
For further information concerning this matter, please call: 
 
                                        at (                        )                               
    Name of Person                                           Area Code    Daytime Telephone Number 
 
    Mailing Address:                                                Street Address: 
    Registration Section                                            Registration Section 
    Division of Corporations                                        Division of Corporations 
    P.O. Box 6327                                                   The Centre of Tallahassee 
    Tallahassee, FL 32314                                           2415 N. Monroe Street, Suite 810 
                                                                    Tallahassee, FL 32303 
     
CR2E136 (12/13) 

        STATEMENT OF ABANDONMENT OF DOMESTICATION 

Pursuant to section 605.1054(3), Florida Statutes, I hereby submit the following Statement of Abandonment of 
Domestication prior to the effective date of the Articles of Domestication: 

FIRST:  The name of the domesticating entity is: 

SECOND:  The Florida Document number of the limited liability company is:                                      

THIRD:  The date articles of domestication were delivered for filing is:                                       

FOURTH:  The domestication has been abandoned in accordance with 605.1054. 

      Authorized Representative of Domesticating Entity               Typed or Printed Name of Signature 
 
             Signature of Authorized Representative                        Typed or Printed Name of Signature 
       
          Filing Fee:                                 $25.00 
          Certified Copy:  $30.00 (optional)