STATEMENT OF 
   PAUL D. PATE 
RESIGNATION OF 
Secretary of State 
 
REGISTERED AGENT 
 State of Iowa 
 
  Readthe instructions onthe next page before completing.
 
All items must be completed before the statement of resignation will be considered.
 
Statement 
 
  Name of BusinessEntity: _____________________________________________________________________
 
 Principal Office Address: ______________________________________________________________________
 
Registered Office Address: ____________________________________________________________________
  
                  TO THE ABOVE NAMED BUSINESS ENTITY: Pleasebeadvisedthatnotice ishereby givento saidbusiness entity that

______________________________________, the registered agent appearing on the records of the secretary of state for
  the business entity, does hereby resignas the registeredagent effective at 12:01 AM on the thirty-first (31st) day after the 

filing date of this Statement or the designation of a new registered agent for the business entity, whichever is earlier. The
registered office of the business entity       is       is not discontinued at the same time.
 
  Signature of RegisteredAgent:___________________________________________________
 
Date: ___________________________
 
Certificate of Mailing 
 
  _________________________________, the registered agent for ________________________________________________,

     appearingontherecords of the secretary of state,hereby certifies that on    _______________________the registered agent 

   did send a copy of this Statement of Resignation of Registered Agent by certifiedmail  to the business entity at the above 

   principal        place of business and to the above registeredoffice,if the office was not discontinued.

  Signature of RegisteredAgent:__________________________________________________
 
Date: ___________________________
 
 635_0987 
 Rev.12/20  
 

                                                                    INSTRUCTIONS
                                                     Read the instructions before completing.

      All items must be completed before the application will be considered.

      Please print or type the information required unless a signature is specified.

      If you are uncertain about the accuracy of any of the required information contact the Secretary of State’s O ce
      at (515) 281-5204 for assistance.

      Each item number below corresponds to the same number as they appear on the Statement or Certificate of Mailing.

                                                                    Statement

      1. Insert the complete legal name of the business entity.
      2.Insert the address of the business entity’s principal place of business.
      3. Insert the address of the registered office.
      4. Insert agent name.
      5.Place an “X” in the appropriate box to indicate whether the registered office is also being discontinued.
      6. Sign the statement.
      7. Insert the date the statement was signed.

                                                         Certificate of Mailing
      1. Insert agent name.
      2. Insert the complete legal name of the business entity.
      3.  Insert the date the statement was mailed to the business entity.
      4. Place an “X” in the box to indicate that the statement was sent to the business entity’s principal office.
      5.  Place   an “X” in the box to indicate that the statement was sent to the registered offices if the registered office is not
          being   discontinued.
  
      6. Sign the certification.

      7. Insert the date the certification was signed.

      NOTES:
      1. There is no filing fee.
      2. The information you provide will be open to public inspection under Iowa Code chapter 22.11.

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

                                                                    Phone: (515)281-5204
                                                                    FAX: (515) 242-5953
                                                             
                                                         Website: sos.iowa.gov