COVER LETTER 
                                                          
TO: Registration Section 
    Division of Corporations 
 
SUBJECT:                                                                                                    
                               Name of Limited Liability Company 
                                                          
Dear Sir or Madam: 
 
The enclosed Withdrawal Statement 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 
                                                                
CR2E140 (2/14) 

                                WITHDRAWAL STATEMENT  
 
Pursuant to section 605.0208, Florida Statutes, I hereby submit the following withdrawal statement withdrawing a 
record before it takes effect: 
 
FIRST:  The name of the limited liability company is:                                                             
 
SECOND:  The Florida Document number of the limited liability company is:                                         

THIRD:  The record to be withdrawn is:                                                                            
 
FOURTH:   Please check the appropriate box 
 
  ☐This withdrawal statement is signed by all the persons who signed the record being withdrawn. 
                                               or 
           ☐ This record is withdrawn in accordance with the agreement of all the persons who signed the record. 
 
     Signature of person submitting withdrawal              Typed or printed name of signature 
 
     Signature of person submitting withdrawal              Typed or printed name of signature 
 
     Signature of person submitting withdrawal              Typed or printed name of signature 
 
     Signature of person submitting withdrawal              Typed or printed name of signature 
 
                               Filing fee:      $25.00 
                               Certified Copy:  $30.00 (optional) 
 
CR2E140 (2/14)