COVER LETTER 

TO: Registration Section 
    Division of Corporations 
 
SUBJECT:                                                                                                              
                                        (Name of Limited Liability Company) 
 
The enclosed member, resignation or dissociation and fee(s) are submitted for filing. 
 
Please return all correspondence concerning this matter to: 
 
                       (Contact Person) 
 
                       (Firm/Company)   
 
                           (Address) 
 
                       (City/State and Zip Code) 
 
For further information concerning this matter, please call: 
 
                                                                        at (               )                          
         (Name of Contact Person)                                           (Area Code & Daytime Telephone Number) 
 
Enclosed please find a check made payable to the Florida Department of State for:  
☐ $25 Filing Fee                                                                   ☐ $55 Filing Fee & Certified Copy                        
                                                                                               
    Mailing Address:                                                                       Street Address: 
    Registration Section                                                                   Registration Section 
    Division of Corporations                                                               Division of Corporations 
    P.O. Box 6327                                                                          The Centre of Tallahassee 
    Tallahassee, FL 32314                                                                  2415 N. Monroe Street, Suite 810 
                                                                                           Tallahassee, FL 32303 
                
CR2E079 (2/14) 

                                                  FLORIDA DEPARTMENT OF STATE  
                                                   DIVISION OF CORPORATIONS 
       
   DISSOCIATION OR RESIGNATION OF MEMBER, MANAGER FROM 
             FLORIDA OR FOREIGN LIMITED LIABILITY COMPANY 
                            (Pursuant to 605.0216, Florida Statutes)  
                                                          
1. The name of the limited liability company as it appears on the records of the Florida Department    
      
    of State is:                                                                           .  
 
2. The Florida document/registration number assigned to this limited liability company is: 
       
                                                          . 
 
3. The date this member/manager withdrew/resigned or will withdraw/resign is:               
 
4. I,                                                     , hereby withdraw/resign as a 
                      (Print Name of Person Resigning)                                  
 
                                                       . 
                                    (Print Title) 
 
   of this limited liability company and affirm the limited liability company has been notified of my       
   resignation in writing.  
 
      Signature of Dissociating Member or Resigning Manager 
 
Filing Fee:            $25.00 (Required) 
Certified Copy:        $30.00 (Optional) 
 
CR2E079 (2/14)