PAUL D. PATE                                  APPLICATION FOR

                   Secretary of State                             CERTIFICATE OF

                         State of Iowa                            WITHDRAWAL

TO THE SECRETARY OF STATE OF THE STATE OF IOWA:

   Pursuant to Iowa law, the undersigned corporation applies for a certificate of withdrawal from Iowa, and states:

1. The name of the corporation is _____________________________________________________________

   and the name the corporation uses in Iowa if different than its real name is:
   _____________________________________________________________________________________

2. The corporation is incorporated under the laws of the state [or foreign country] of ______________________

3. The corporation is not transacting business in Iowa and surrenders its authority to transact business in Iowa.

4. The corporation revokes the authority of its registered agent to accept service on its behalf and appoints the
   secretary of state as its agent for service of process in any proceeding based on a cause of action arising
   during the time it was authorized to transact business in Iowa.

5. The mailing address to which the secretary of state may mail a copy of any process served on the
   secretary of state is:

   Name ________________________________________________________________________________
   Address_______________________________________________________________________________

   City, State, ZIP _________________________________________________________________________

   The corporation will notify the secretary of state in the future of any change in this mailing address.

   Date ______________________________

   Signature______________________________________________________________________________

   Type or print name and title _______________________________________________________________

The filing fee is: $10.00 - Profit Corporations
                   $  5.00 - Nonprofit Corporations
                   Make checks payable to SECRETARY OF STATE

635_0115
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NOTES:

1. The filing fee is $10.00 - Profit Corporations
         $   5.00 - Nonprofit Corporations
         Make checks payable to SECRETARY OF STATE

2. The document is to be signed by the chairperson of the board, the president, or other officer of the corpora-
tion.  If directors have not been selected, the document is to be signed by an incorporator.  If the corporation
is in the hands of a court appointed fiduciary, the document is to be signed by the fiduciary.  A copy of a
signature is acceptable for filing.  Verification is not required.

3. One copy of the document is to be delivered to the secretary of state for filing.

4. The effective time and date of the document is the later of the following:
a. the time of filing on the date it is filed;
b. the time specified in the document on the date it is filed;
c. the time and date specified in the document, not later than 90 days after the date it is filed.

5. The information you provide will be open to public inspection under Iowa Code section 22.11.

                                              SECRETARY OF STATE
          Business Services Division
                                              Lucas Building, 1st Floor
                                              Des Moines, Iowa  50319

                                              Phone:  (515) 281-5204
                                              FAX:  (515) 242-5953

635_0115                                      Website: sos.iowa.gov
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