S                                                                  (225) 925-4704
                                              TATE OF LOUISIANA                                            Commercial Division    
                                        SECRETARY OF STATE
Nancy Landry                                                                                               Fax Numbers 
SECRETARY OF STATE                                                                                         (225) 932-5314 Corporations
                                                                                                           (225) 932-5317 Legal Services
                                                                                                           (225) 932-5318 UCC

                            TRANSMITTAL INFORMATION 
                                  For All Business Filings

Please indicate below the level of service requested, payment and contact information

     Routine         Expedite $30                         Priority Expedite $50
                     24 hour processing                  2-4 hour processing

     Check or Money Order Enclosed

*Do not put credit card information on this form. You may save payment information in your geauxBIZ profile under master account.

Business Name (List  exactly  as it appears in documents)

Name of person filing document (evidence of filing will be mailed to this person, at address below)

Address

City                                     State                                                     Zip Code

Daytime phone number                    Fax number                                                 Email address

NOTE:  Louisiana Law requires all Louisiana notaries to print or type their name and notary or 
              bar roll number on the document.

                     Mailing Address:  P. O. Box 94125, Baton Rouge, LA * 70804-9125      
                     Office Location: 8585 Archives Ave.,  Baton Rouge, LA * 70809          
                                  Web Site Address:   www.sos.la.gov

 SS984  Rev. 01/24

            Nancy Landry                APPLICATION FOR WITHDRAWAL OF A FOREIGN CORPORATION/
Secretary of State                      LIMITED LIABILITY COMPANY FROM THE STATE OF LOUISIANA
                                                              (R.S. 12:312 & 12:1351)

                           Enclose $125 (Corporation) filing fee       Return  to: Commercial Division
                           $150 (Limited Liability Company) filing fee             P.O. Box 94125
                           Make remittance payable to                              Baton Rouge, LA 70804-9125 
                                           Secretary of State                      (225) 925-4704
                                         Do Not Send Cash                          www.sos.la.gov

STATE OF

PARISH/COUNTY OF

                                          Company Name

organized under the laws of the state/country of                        is no longer transacting business in 

the State of Louisiana, effective                                surrenders its authority to transact business in the 

state of Louisiana; revokes the authority of its registered agent to accept service of process, and consents that 

service of  process in any action or proceeding based on any cause of action arising out of or resulting from or 

connected with  any business transacted by it in this State during the time the company was authorized to transact 

business in this State, be made on the company by service thereof on the Secretary of State, or on a person in his 

office designated  to receive service of process; such service, if made on the Secretary of State.

                                        Officer/Manager or Member                                 Date

Sworn to and subscribed before me, the undersigned Notary Public, on this date:

                                                 Notary

SS338 Rev. 01/24                                                                     (see instructions on back)

                                      INSTRUCTIONS

1. A foreign corporation or limited liability company authorized to transact business in this state may
   withdraw from this state upon procuring from the Secretary of State a Certificate of Withdrawal.

2. In order to obtain a Certificate of Withdrawal, this application must be executed in duplicate by any
   officer for a corporation, or by a manager, if management of the limited liability company is vested
   in one or more managers, or a member, if management is reserved to the members, for a limited
   liability company.  The application must be acknowledged by the signing party before a notary
   public.  (If the withdrawal is for a corporation which is in the hands of a receiver or a trustee, this
   form shall be executed on behalf of the corporation by such receiver or trustee and     acknowledged
   by him.)

3. A Certificate of Withdrawal shall be issued when all fees, charges, taxes, unemployment
   compensation, distributions and interest have been paid as required by law and evidenced by
   certificates of the Collector of Revenue and the Administrator of the Division of Employment
   Security of the Department of Labor.  (The Secretary of State’s Office requests these  ertificatesc
   from the above offices.)

4. Upon the issuance of a Certificate of Withdrawal, the authority of the company to transact business
   in Louisiana shall cease.