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Sec. 183.1011 Wis. Stats.

State of Wisconsin DEPARTMENT OF FINANCIAL INSTITUTIONS Division of Corporate & Consumer Services

FOREIGN LIMITED LIABILITY COMPANY ­ WITHDRAWAL APPLICATION
1. (Name of foreign limited liability company) company organized under the laws of (state/country) registration to transact business in Wisconsin, hereby surrenders that registration, applies for a Certificate of Withdrawal, and states: A. The foreign limited liability company is not transacting business in Wisconsin. B. The authority of its registered agent to accept service of process on its behalf is hereby revoked. C. The foreign limited liability company hereby consents to service of process under sec. 183.1010(3) and (4) of the Wisconsin Statutes in any civil, criminal, administrative or investigatory proceeding based on a cause of action arising during the time it was registered to transact business in Wisconsin. D. The address to which a copy of any process against the foreign limited liability company may be mailed is: and holding a certificate of , a foreign limited liability

E. The foreign limited liability company agrees to notify the Department of Financial Institutions of any future change in the address to which a copy of any process is to be mailed. 2. Executed on Title: (Date) Member OR Manager (Signature)

(Select and mark (X) the one appropriate title) (Printed name) _________________________________________________________________________________

FILING FEE - $40.00

See instructions, suggestions and procedures on following page. DFI/CORP/524(R04/22/03) Use of this form is mandatory. (Earlier editions, 1998 and later, may be used) 1 of 2

FOREIGN LIMITED LIABILITY COMPANY WITHDRAWAL APPLICATION




Your return address and phone number during the day: (

) _____ -

___________

INSTRUCTIONS (Ref. sec. 183.1011, Wis. Stats., for document content) Submit one original and one exact copy to Department of Financial Institutions, P O Box 7846, Madison WI, 53707-7846, together with the appropriate FILING FEE of $40. Filing fee is nonrefundable. (If sent by Express or Priority U.S. mail, address to 345 W. Washington Ave., 3rd Floor, Madison WI, 53703). Sign the document manually or otherwise as allowed under sec. 183.1011, Wis. Stats. NOTICE: This form may be used to accomplish a filing required or permitted by statute to be made with the department. Information requested may be used for secondary purposes. If you have any questions, please contact the Division of Corporate & Consumer Services at 608-261-7577. Hearing-impaired may call 608-266-8818 for TTY. This document can be made available in alternate formats upon request to qualifying individuals with disabilities. 1. Enter the name of the foreign limited liability company and the state in which it is organized. If the company holds its certificate of registration under a fictitious name, provide the fictitious name as well. A, B & C. These statements are required by sec. 183.1011(2)(b) and (c). D. Provide an address to which a copy of any process against the foreign limited liability company may be mailed. 2. The application is to be executed by either a member or a manager of the company. Print or type the name of the person signing the application, the date, and indicate whether signing as a member or as a manager.

DFI/CORP/524I(R04/22/03)

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