COVER LETTER 
                                                                            
TO:   Registration Section 
        Division of Corporations 
 
SUBJECT:                                                                                                             
 
DOCUMENT NUMBER:                                                                                                     
 
The enclosed Notice of Limited Liability Company Dissolution and fee are submitted for filing. 
 
Please return all correspondence concerning this matter to the following: 
 
                                    (Name of Contact Person) 
 
                                    (Firm/Company) 
 
                                                                         (Address)  
 
                             (City/State and Zip Code) 
                                                                            
For further information concerning this matter, please call: 
 
                                                                           at (       )                                       
               (Name of Contact Person)                                         (Area Code)       (Daytime Telephone Number) 
 
Enclosed is a check for the following amount: 
 
☐$25 Filing Fee        ☐$30 Filing Fee &       ☐$55 Filing Fee &        ☐$60 Filing Fee, 
                                  Certificate of Status       Certified Copy               Certificate of Status & Certified 
                                                 (Additional copy is enclosed)     Copy (Additional copy 
                                                                                           is enclosed) 
 
 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 
 
CR2E142 (2/14) 
                                                                            

                          Notice of Limited Liability Company Dissolution 
                                                                 
This notice is submitted by the dissolved limited liability company named below for resolution of payment of 
unknown claims against this limited liability company as provided in s. 605.0712, F.S.  
 
This "Notice of Limited Liability Company Dissolution" is optional and is not required when filing a voluntary 
dissolution. 
 
Name of Limited Liability Company:                                                                                
 
Document number of Limited Liability Company is:                                                                 
 
Date of dissolution was:                                        
 
Description of information that must be included in a written claim:  
 
Mailing address where claims can be sent: (Claims cannot be sent to the Division of Corporations) 
 
A claim against the above named limited liability company will be barred unless a proceeding to enforce the claim is 
commenced within 4 years after the filing of this notice. 
 
                          Printed Name of the Person Filing                    Signature of the Person Filing  
                                    
             Fee:  No charge if included with Articles of Dissolution.  If filed separately $25.00