COVER LETTER 
                                                 
TO: Registration Section 
    Division of Corporations 
 
SUBJECT:                                                                                               
                                Name of Limited Liability Company 
                                                 
Dear Sir or Madam: 
 
The enclosed Amendment or Cancellation of Statement of Authority 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 
                
CR2E145 (2/14) 

              AMENDMENT OR CANCELLATION OF STATEMENT OF AUTHORITY 
                                                        
Pursuant to section 605.0302(2), Florida Statutes, this limited liability company submits the following: 
 
FIRST:  The name of the limited liability company is:                                                      
 
SECOND: The Florida Document number of the limited liability company is:                                   

THIRD:  The street address of the limited liability company’s principal office is: 
 
         The mailing address of the limited liability company’s principal office is: 
 
FOURTH:  The date the statement of authority became effective is:                      
 
FIFTH:       The statement of authority is cancelled. 
 
OR 
 
               The amendment to the statement of authority is   
 
____________________________________                            ________________________________ 
Signature of authorized representative                             Typed or printed name of signature 
                                        
                                       Filing Fee:      $25.00 
                                       Certified Copy:  $30.00 (optional) 

CR2E145 (2/14)