COVER LETTER 
                                                 
TO: Registration Section 
    Division of Corporations 
 
SUBJECT:                                                                                                
                                Name of Limited Liability Company 
                                                 
Dear Sir or Madam: 
 
The enclosed Statement of Abandonment of Conversion and fee(s) are submitted for filing. 
 
Please return all correspondence concerning this matter to the following: 
 
                          Name of Person 
 
                          Firm/Company 
 
                   Address 
 
               City/State and Zip Code 
 
          E-mail address: (to be used for future annual report notification) 
 
For further information concerning this matter, please call: 
 
                                                 at (                        )                          
               Name of Person                           Area Code        Daytime Telephone Number 
 
    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 
                
CR2E135 (2/14) 

                STATEMENT OF ABANDONMENT OF CONVERSION 

Pursuant to section 605.1044(3), Florida Statutes, I hereby submit the following Statement of Abandonment of 
Conversion prior to the effective date of the Articles of Conversion: 

FIRST:  The name of the converting limited liability company is: 

SECOND:  The date articles of conversion were delivered for filing is:                                           

THIRD:  The conversion has been abandoned in accordance with s. 605.1044, Florida Statutes. 

_______________________________________                               ___________________________________ 
Authorized Representative of Converting Entity                               Typed or Printed Name of Signature 

___________________________________                                 ____________________________________ 
Signature of Authorized Representative                                     Typed or Printed Name of Signature 

                                       Filing Fee:      $25.00 
                                       Certified Copy:   $30.00 (optional) 

CR2E135 (2/14)