Free LLCFF72642.WPD - Nebraska

APPLICATION FOR WITHDRAWAL OF FOREIGN LIMITED LIABILITY COMPANY
Submit in Duplicate

John A. Gale, Secretary of State Room 1301 State Capitol, P.O. Box 94608 Lincoln, NE 68509 (402) 471-4079
http://www.sos.state.ne.us.

Name of Limited Liability Company_________________________________________ _____________________________________________________________________ Organized under the laws of the State of _________________________ The company is no longer transacting business in the State of Nebraska and surrenders its authority to transact business in the state of Nebraska The limited liability company revokes the authority of its registered agent in this state to accept service of process and consents that service in any action suit or proceeding based upon any cause of action arising in this state during the time the limited liability company was authorized to transact business in this state be made on the company outside the state. Post office address at which process against the company may be served: _____________________________________________________________________
Street Address City State Zip

____________________________________
Signature of Member

___________________________________
Printed name of Member

FILING FEE: $25.00

Revised 12/19/2000

Neb. Rev. Stat. 21-2642