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

Surrender of Modified Name
(PURSUANT TO NRS 80.025)

USE BLACK INK ONLY - DO NOT HIGHLIGHT

ABOVE SPACE IS FOR OFFICE USE ONLY

Surrender of Modified Name (Pursuant to NRS 80.025)

Complete if name in home state is now available for use in Nevada

current modified name

a corporation qualified to do business in the State of Nevada under the above modified name does hereby resolve this
day

day of
month

to adopt the use of its actual corporate name,
year

corporate name in domicile state

which is now available for use in the State of Nevada.

X
Authorized Signature Title

FILING FEE: $50.00

This form must be accompanied by appropriate fees.

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Nevada Secretary of State Modified Name Surrender Revised: 4-9-09