STATEMENT OF INTENT TO DISSOLVE 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_________________________________________ _____________________________________________________________________ This statement of intent to dissolve the above named limited liability company is being filed due to the occurrence one of the following events specified in Neb. Rev. Stat. ยง21-2622 and described below: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
___________________________________
Signature of Member
Or Or
____________________________________
Signature of Manager
___________________________________
Printed Name of Member
____________________________________
Printed Name of Manager
FILING FEE: $15.00
Revised 12/19/2000
Neb. Rev. Stat. 21-2623