Free Form - Nevada

ROSS MILLER Secretary of State 204 North Carson Street, Suite 1 Carson City, Nevada 89701-4520 (775) 684 5708 Website: www.nvsos.gov

Statement of Cancellation
by Nonfiling Domestic and Nonqualified Foreign Entities (PURSUANT TO NRS 77.380)

USE BLACK INK ONLY - DO NOT HIGHLIGHT

ABOVE SPACE IS FOR OFFICE USE ONLY

1. Name of Entity:

2. File Number:

3. This entity is canceling its appointment of the following registered agent as agent for service of process in Nevada:

4. Signature:

X
Authorized Signature of Nonfiling Entity Date

FEE: $50.00
This form must be accompanied by appropriate fees.
Nevada Secretary of State Form RA Misc Cancellation Effective: 5-15-09

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