COVER LETTER 
                                                   
TO:   Registration Section 
      Division of Corporations 
 
SUBJECT:                                                                                
                                       Name of Limited Liability Company 
                                                   
Dear Sir or Madam: 
 
The enclosed Statement of Termination 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 
                
CR2E141 (2/14) 

                  STATEMENT OF TERMINATION 

Pursuant to section 605.0709(7), Florida Statutes, I hereby submit the following Statement of Termination: 

FIRST:  The name of the limited liability company is:                                                          

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

THIRD:  The date of filing of the initial articles of organization is:                                         

FOURTH:  The date of filing of the dissolution is: _______________________________________. 

FIFTH:  This limited liability company has completed winding up its activities and affairs and has determined 
that it will file a statement of termination. 

__________________________________      ____________________________________ 
Signature of Authorized Representative               Typed or printed name of signature 

                                               Filing Fee:  $25.00 
                   Certified Copy: $30.00 (optional) 

CR2E141 (2/14)